Lakeside Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010850 Issued in WA

Legal business name

LAKESIDE DENTAL

Practice address

1708 South Clover Drive
Moses Lake, WA 98837

Phone

(509) 764-0307

Fax

(509) 764-0886

NPI assigned

Aug 19, 2008

Organization subpart

No

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

Authorized official

Name

Lori Munson

Title

Office Manager

Phone

(509) 764-0307

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Levi Scott Miller, DMD

  • General Practice Dentistry
  • Moses Lake, WA
  • NPI 1598920340
  NPD (past)

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1447407739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 SOUTH CLOVER DRIVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "98837",
            "telephone_number": "509-764-0307",
            "fax_number": "509-764-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 SOUTH CLOVER DRIVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "98837",
            "telephone_number": "509-764-0307",
            "fax_number": "509-764-0886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "MUNSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-764-0307"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010850",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60028802",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5056627",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trisha Kruger, M.D.
• Karl Christopher Kubo, MD
• Amber Kuntz
• Nicole Christine Labban, DO
• Laboratory Corporation of America
• Lakeside Optical Dispensary, Inc.
• Laketown Pharmacy PLLC
• Meghan Lamb, MSW, LICSWA
• Thomas Joachim Laney, D.D.S. , M.D.
• Jay R Lapratt

• General Practice Dentistry in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.