| Lakeside Dental | |
|
3090 Winghaven Blvd O Fallon MO 63368 | |
| (636) 561-0800 | |
| (636) 625-0088 |
| Full Name | Lakeside Dental |
|---|---|
| Speciality | Dentist |
| Location | 3090 Winghaven Blvd, O Fallon, Missouri |
| Authorized Official Name and Position | Sherri Lynn Poettker (DENTIST OWNER) |
| Authorized Official Contact | 6365610800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Dental 3090 Winghaven Blvd O Fallon MO 63368 Ph: (636) 561-0800 | Lakeside Dental 3090 Winghaven Blvd O Fallon MO 63368 Ph: (636) 561-0800 |
| NPI Number | 1144426214 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144426214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2003000402 (Missouri) | Primary |
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