Lakeside Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5496 Issued in WI

Legal business name

LAKESIDE DENTAL LLC

Practice address

5600 W Brown Deer Rd
Suite 111
Milwaukee, WI 53223-2311

Phone

(414) 355-5020

NPI assigned

Jun 17, 2016

Organization subpart

No

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

Authorized official

Name

Deanna Villagran

Title

Office Manager

Phone

(414) 355-5020

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Nathan H Knutsen, D.D.S

  • Dentist
  • Milwaukee, WI
  • NPI 1073633699
  NPD (past)

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

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1518317858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 W BROWN DEER RD",
            "address_2": "SUITE 111",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532232311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 W BROWN DEER RD",
            "address_2": "SUITE 111",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532232311",
            "telephone_number": "414-355-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "VILLAGRAN",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "414-355-5020"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5496",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "100132615",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshore Clinic LTD
• Lakeshore Medical Clinic
• Lakeshore Medical Clinic, LLC
• Lakeshore Medical Clinic, LTD
• Lakeshore Medical Clinic, LTD
• Lakeside OB/GYN, S.C.
• Alysandra Lal, M.D.
• Dave R Lal, M.D.
• Beth M Lalande, MD
• Aarish Lalani, M.D.

• General Practice Dentistry in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; 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.