LAKESHORE COMMUNITY DENTAL CLINIC (NPI# 1023275013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023275013 |
| Entity Type | Organization |
| Organization Name | LAKESHORE COMMUNITY DENTAL CLINIC |
| Other Organization Name | LAKESHORE TECHNICAL COLLEGE |
| Practice Address |
1290 North Ave Lakeshore Community Dental Clinic Cleveland WI 53015-1412 |
| Practice Telephone | 9206931386 |
| Mailing Telephone | 9206931386 |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |
| Authorized Official Name | MS. BARBARA J DODGE (DEAN, HEALTH AND HUMAN SERVICES) |
| Authorized Official Telephone | 9206931386 |
| Authorized Official Credential | PH.D., R.N. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 38394700 | 05 |
| Other Name | Type Code |
|---|---|
| Lakeshore Technical College | Other Name - Individual/Organization |
| Street Address |
1290 NORTH AVE LAKESHORE COMMUNITY DENTAL CLINIC |
| City | CLEVELAND |
| State | WI |
| Zip Code | 53015-1412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942392428 | Gary J Kunz | Nurse Practitioner | 1205 North Avenue, Cleveland, WI 53015 | 2006-09-29 |
| 1437611159 | Tss Equipment Company | Technician, Other | 14302 Pigeon River Rd, Cleveland, WI 53015-1158 | 2019-04-02 |
| 1760807259 | Nathan Nitka | Dietitian, Registered | 1205 North Ave, Cleveland, WI 53015-1413 | 2014-02-20 |
| 1295060275 | Tao Lee | Nurse Practitioner | 1205 North Ave, Cleveland, WI 53015-1413 | 2009-10-08 |
| 1184860124 | Carrie Lynne Oakley | Registered Nurse | 1205 North Ave, Cleveland, WI 53015-1413 | 2008-12-22 |
| 1841496486 | Charlene Mae Baumgartner | Registered Nurse | 1205 North Ave, Cleveland, WI 53015-1413 | 2007-06-21 |
| 1013010024 | Amy Sue Mckenzie | Counselor | 1205 North Ave, Cleveland, WI 53015-1413 | 2006-09-06 |
| 1154337558 | Cleveland Va Cboc | Clinic/Center | 1205 North Ave, Cleveland, WI 53015-1413 | 2006-07-31 |
| 1417961590 | Jamie Lauren Olsen | Dietitian, Registered | 1205 North Ave, Cleveland, WI 53015-1413 | 2006-07-27 |
| 1174537245 | Sue E. Thobaben | Registered Nurse | 1205 North Ave, Cleveland, WI 53015-1413 | 2006-07-27 |
| Find all providers in zip 53015 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659723534 | Innovative Dental | Clinic/Center | 13922 Cedar Rd Ste 3, Cleveland, OH 44118-3204 | 2016-07-05 |
| 1407207103 | Union Dental Care, Jeffrey J. Hildebrandt, Dds, Inc. | Clinic/Center | 17535 Rosbough Blvd Ste 203, Cleveland, OH 44130-8362 | 2016-06-24 |
| 1639537616 | Broadway Family Dental Presented By Dr. Tariq Sayegh Bds LLC | Clinic/Center | 5716 Broadway Avenue, Cleveland, OH 44127-1715 | 2016-02-04 |
| 1821118787 | M. J. Chrzanowski, D.d.s., Inc. | Clinic/Center | 782 E 185th St, Cleveland, OH 44119-2174 | 2007-04-01 |
| 1396874426 | Care Alliance | Clinic/Center | 1530 Saint Clair Avenue, Cleveland, OH 44114-2004 | 2007-03-05 |
| 1750418380 | Denison Dental Assoc Inc | Clinic/Center | 7140 Denison Ave, Cleveland, OH 44102 | 2007-02-28 |
| 1225648017 | Youstina Mozeih Shaker Mikhail | Clinic/Center | 9601 Chester Ave, Cleveland, OH 44106-1666 | 2020-08-05 |
| 1952919714 | Brooklyn Dental Group, Jeffrey S. Rosenthal, D.d.s., Inc. | Clinic/Center | 4163 Pearl Rd, Cleveland, OH 44109-3332 | 2020-07-17 |
| 1124644455 | Delta Family Dental, Pllc | Clinic/Center | 201 W Sunflower Rd, Cleveland, MS 38732-2637 | 2020-06-23 |
| 1215569587 | Dental Associates of Cleveland | Clinic/Center | 33 Mouse Creek Rd Nw, Cleveland, TN 37312-4840 | 2020-02-05 |
| Find all providers in CLEVELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.