Provider Demographics
NPI:1932706595
Name:LAKE FRONT DENTAL GROUP PC
Entity Type:Organization
Organization Name:LAKE FRONT DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIKHZER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-561-0301
Mailing Address - Street 1:205 W BAY PLZ
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1786
Mailing Address - Country:US
Mailing Address - Phone:518-561-0301
Mailing Address - Fax:
Practice Address - Street 1:205 W BAY PLZ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1786
Practice Address - Country:US
Practice Address - Phone:518-561-0301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty