Provider Demographics
NPI:1972727253
Name:LAKESIDE ENDODONTICS
Entity type:Organization
Organization Name:LAKESIDE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-598-1600
Mailing Address - Street 1:22 ROUTE 10 WEST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-598-1600
Mailing Address - Fax:973-598-1618
Practice Address - Street 1:22 STATE ROUTE 10 W
Practice Address - Street 2:SUITE 102
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1731
Practice Address - Country:US
Practice Address - Phone:973-598-1600
Practice Address - Fax:973-598-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1019563001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty