Provider Demographics
NPI:1588973093
Name:LAKE GEORGE DENTAL
Entity type:Organization
Organization Name:LAKE GEORGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-202-3001
Mailing Address - Street 1:163 W 1ST AVE
Mailing Address - Street 2:P.O. BOX 960
Mailing Address - City:PIERSON
Mailing Address - State:FL
Mailing Address - Zip Code:32180-2200
Mailing Address - Country:US
Mailing Address - Phone:386-202-3001
Mailing Address - Fax:386-202-3002
Practice Address - Street 1:163 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:PIERSON
Practice Address - State:FL
Practice Address - Zip Code:32180-2200
Practice Address - Country:US
Practice Address - Phone:386-202-3001
Practice Address - Fax:386-202-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN147961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty