Lake Harbor Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3044 Issued in ID

Legal business name

LAKE HARBOR DENTAL

Practice address

5355 W State St
Boise, ID 83703-3333

Phone

(208) 853-4687

Fax

(208) 853-4690

NPI assigned

Mar 16, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Michael Eugene Peterson, DDS, PA

Title

President

Phone

(208) 853-4687

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1639310089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5355 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033333",
            "telephone_number": "208-853-4687",
            "fax_number": "208-853-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5355 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837033333",
            "telephone_number": "208-853-4687",
            "fax_number": "208-853-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HARBOR DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-853-4687",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS, PA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3044",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4142",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina C. Laface, PT
• Chelsea Louise Lafee, LMSW
• Laura W Laforte, LCSW
• Ryann Lynn Lagomarsino
• Katherine M Laible, PAC
• Lake Harbor Dental PLLC
• Lake Harbor Internal Medicine
• Lake Harbor Internal Medicine Assoc LLC
• Juliana Lake, LMSW
• Christopher Lakey

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; 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.