| Lake Road Dental Llc | |
|
4622 Shannon Lake Rd Dillingham AK 99576 | |
| (907) 842-2324 | |
| Not Available |
| Full Name | Lake Road Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4622 Shannon Lake Rd, Dillingham, Alaska |
| Authorized Official Name and Position | Kelly Lucas (DENTIST/ OWNER) |
| Authorized Official Contact | 9078422324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Road Dental Llc Po Box 969 Dillingham AK 99576-0969 Ph: (907) 842-2324 | Lake Road Dental Llc 4622 Shannon Lake Rd Dillingham AK 99576 Ph: (907) 842-2324 |
| NPI Number | 1174016737 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 06/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174016737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Bristol Bay Area Health Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6000 Kanakanak Rd, Dillingham, AK 99576 Phone: 907-842-5201 Fax: 907-842-9250 |