Provider Demographics
NPI:1053968917
Name:LAKEWOOD DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:LAKEWOOD DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNGERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-899-7950
Mailing Address - Street 1:15711 MADISON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5655
Mailing Address - Country:US
Mailing Address - Phone:216-228-7950
Mailing Address - Fax:
Practice Address - Street 1:15711 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5655
Practice Address - Country:US
Practice Address - Phone:216-228-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental