LAKE ROAD DENTAL LLC (NPI# 1174016737) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174016737 |
| Entity Type | Organization |
| Organization Name | LAKE ROAD DENTAL LLC |
| Practice Address |
4622 Shannon Lake Rd Dillingham AK 99576 |
| Mailing Address |
Po Box 969 Dillingham AK 99576-0969 |
| Practice Telephone | 9078422324 |
| Mailing Telephone | 9078422324 |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2018-06-08 |
| Authorized Official Name | KELLY LUCAS (DENTIST/ OWNER) |
| Authorized Official Telephone | 9078422324 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
4622 SHANNON LAKE RD |
| City | DILLINGHAM |
| State | AK |
| Zip Code | 99576 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053837823 | Guardian Flight LLC | Ambulance | Beluga Bluffs Apt Block 26, Lot 5 Apt. 5 & 6, Dillingham, AK 99576 | 2017-08-14 |
| 1467820910 | Alicia Mahlow | Case Manager/Care Coordinator | 540 Gauthier Way, Dillingham, AK 99576 | 2015-09-14 |
| 1306100557 | Peter Tallman | Social Worker | 6000 Kanakanak, Dillingham, AK 99576 | 2012-07-02 |
| 1801079546 | Marrulut Eniit Assisted Living, Inc | Respite Care | 125 D Street, Dillingham, AK 99576 | 2007-12-17 |
| 1730393430 | City of Dillingham | Ambulance | 514 Main Street, Dillingham, AK 99576 | 2007-05-10 |
| 1023132792 | City of Dillingham Senior Center | Non-emergency Medical Transport (VAN) | 515 East 1st Ave, Dillingham, AK 99576 | 2007-03-19 |
| 1912037037 | Hope Community Resources Inc | Day Training, Developmentally Disabled Services | Chog Center Main Street, Dillingham, AK 99576 | 2007-03-07 |
| 1427119874 | Bristol Bay Area Health Corporation | Clinic/Center | Main Steet, Portage Creek, AK 99576 | 2006-12-12 |
| 1396728614 | Joan Lucienne Junge | Nurse Practitioner | 1500 Kanakanak Rd, Dillingham, AK 99576 | 2005-11-21 |
| 1760465181 | Juliana Christine Montooth | Family Medicine | 6000 Kanakanak Rd, Dillingham, AK 99576 | 2005-11-21 |
| Find all providers in zip 99576 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962011593 | Deyoung Dentistry, LLC | Clinic/Center | 2601 Boniface Parkway Suite 1, Anchorage, AK 99504 | 2020-07-29 |
| 1205461084 | Hawkinson Dental Inc | Clinic/Center | 6200 Lake Otis Pkwy Ste 101, Anchorage, AK 99507-2098 | 2020-03-11 |
| 1982238622 | Donald R Mclean | Clinic/Center | 3719 E Meridian Loop Ste B, Wasilla, AK 99654-7273 | 2020-03-02 |
| 1740745439 | Susan Olson Dmd Inc | Clinic/Center | 3261 S. Big Lake Rd. Ste D3-d4, Big Lake, AK 99652 | 2019-02-06 |
| 1932664877 | Alaska Family Dental LLC | Clinic/Center | 405 W 36th Ave Ste 101, Anchorage, AK 99503-5872 | 2019-02-05 |
| 1659862134 | Evelyn Haley Dmd | Clinic/Center | 615 E 82nd Ave Ste 100, Anchorage, AK 99518-3100 | 2018-05-21 |
| 1891285433 | Alaskan Family Dental Center LLC | Clinic/Center | 281 N Main St Ste 201, Wasilla, AK 99654-7046 | 2018-05-17 |
| 1376051797 | Caroline Curtis Dmd PC | Clinic/Center | 16635 Centerfield Dr Ste 207, Eagle River, AK 99577-7746 | 2018-01-19 |
| 1417475716 | Michael G. Crookston Dds PC | Clinic/Center | 11723 Old Glenn Hwy Ste 207, Eagle River, AK 99577-7750 | 2017-09-07 |
| 1982133682 | Offshore Drilling LLC | Clinic/Center | Po Box 18047, Coffman Cove, AK 99918-0047 | 2017-06-06 |
| Find all providers with the same taxonomy | ||||
| City | DILLINGHAM |
| Zip Code | 99576 |
Please comment or provide details below to improve the information on LAKE ROAD DENTAL LLC.
| 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.