| Lakeland Family Dental, Llc | |
|
1300 N Summit Ave Suite 101 Oconomowoc WI 53066-4467 | |
| (262) 567-1323 | |
| Not Available |
| Full Name | Lakeland Family Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 1300 N Summit Ave, Oconomowoc, Wisconsin |
| Authorized Official Name and Position | Samantha Jean Ruiz (OWNER) |
| Authorized Official Contact | 2627059076 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeland Family Dental, Llc 910 Oconomowoc Pkwy Oconomowoc WI 53066-4615 Ph: () - | Lakeland Family Dental, Llc 1300 N Summit Ave Suite 101 Oconomowoc WI 53066-4467 Ph: (262) 567-1323 |
| NPI Number | 1518418243 |
|---|---|
| Provider Enumeration Date | 10/18/2016 |
| Last Update Date | 10/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518418243 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6544-15 (Wisconsin) | Primary |
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