Lakeshore Mall Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKESHORE MALL DENTAL GROUP

Practice address

150 Pearl Nix Pkwy
Suite B10
Gainesville, GA 30501-3548

Phone

(770) 536-1957

Fax

(770) 536-3582

NPI assigned

Feb 5, 2007

Last updated

Aug 22, 2020By 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

Theresa Chatham

Title

Dist Manager

Phone

(770) 536-1957

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346389814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 PEARL NIX PKWY",
            "address_2": "SUITE B10",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013548",
            "telephone_number": "770-536-1957",
            "fax_number": "770-536-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PEARL NIX PKWY",
            "address_2": "SUITE B10",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013548",
            "telephone_number": "770-536-1957",
            "fax_number": "770-536-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MALL DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHATHAM",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "DIST MANAGER",
        "authorized_official_telephone_number": "770-536-1957"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Lanier Anesthesia Associates, LLC
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• Andrew N Lake, MD
• Lisa Ramsland Lake, OTR/L
• Lakeshore Chiropratic
• Lakeshore Tubal Reversal Center (Lakeshore Surgical Center)
• Lakeside Family Medicine
• Lakeside Integrated Group, LLC
• Lakeside OB/GYN and Pelvic Surgery, LLC
• Sanjay M Lall, M.D.

• General Practice Dentistry in Gainesville, GA
• Providers in Gainesville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.