National Provider Identifier Database

LAKE CITY DENTAL SPECIALTIES PC
Periodontics

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.


Contact Information

LAKE CITY DENTAL SPECIALTIES, PC
1322 W KATHLEEN AVE STE 2
COEUR D'ALENE, ID83815-7365
Phone: 208-664-7300
Fax: 208-664-7333
Website:
Specialty Taxonomy Code
* Periodontics 1223P0300X
Endodontics 1223E0200X

* Indicates primary specialty

NPI Profile & details for LAKE CITY DENTAL SPECIALTIES, PC

NPI Number 1356693915
Legal business name
LBN
LAKE CITY DENTAL SPECIALTIES, PC
Authorized official SHAUN WHITNEY - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 10/07/2012
Last updated 10/07/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • ID License #: D4420EN
  • ID License #: D4420PE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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