| Lake Country Dental P.l.l.c | |
|
404 William St Ste 5 Geneva NY 14456-2143 | |
| (315) 789-3067 | |
| (315) 789-0056 |
| Full Name | Lake Country Dental P.l.l.c |
|---|---|
| Speciality | Clinic/Center |
| Location | 404 William St Ste 5, Geneva, New York |
| Authorized Official Name and Position | Lisa Kay Mulkin (OWNER/DENTIST) |
| Authorized Official Contact | 3157893067 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Country Dental P.l.l.c 404 William St Ste 5 Geneva NY 14456-2143 Ph: (315) 789-3067 | Lake Country Dental P.l.l.c 404 William St Ste 5 Geneva NY 14456-2143 Ph: (315) 789-3067 |
| NPI Number | 1396274452 |
|---|---|
| Provider Enumeration Date | 06/12/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7214299577 |
|---|---|
| Medicare Enrollment ID | O20180326001962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396274452 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 050514 (New York) | Primary |
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Sia N. Hersini, Dmd, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 William St, Suite D, Geneva, NY 14456 Phone: 315-789-9054 Fax: 315-781-1297 |