Lakeshore Dental Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKESHORE DENTAL INC.

Practice address

1200 Gold Hill Road
Fort Mill, SC 29708

Phone

(803) 396-0000

Fax

(803) 396-0001

NPI assigned

Feb 22, 2018

Last updated

Nov 1, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeff Cohen

Title

Coo

Phone

(704) 246-8971

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1255832549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 GOLD HILL ROAD",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 GOLD HILL ROAD",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "29708",
            "telephone_number": "803-396-0000",
            "fax_number": "803-396-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-246-8971"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Anne Kyzer, R.PH.
• Kathleen Jendron Labarowski, MSP CCC-SLP
• Melissa Labate, MS, CHES, FMCHC
• Kendall Lahr, OTD
• Amanda Joy Lake, PHARMD
• Lakeshore Dental LLC
• Lakeside Audiology LLC
• Stephanie Lamp, BT
• Dionne Land-Prophet, RPH
• Amy Lane, RBT

• General Practice Dentistry in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.