Provider Demographics
NPI:1730338096
Name:LAKEWINDS DENTAL CENTRE
Entity type:Organization
Organization Name:LAKEWINDS DENTAL CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CAITHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-845-7240
Mailing Address - Street 1:409 W LUDINGTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2377
Mailing Address - Country:US
Mailing Address - Phone:231-845-7240
Mailing Address - Fax:
Practice Address - Street 1:409 W LUDINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2377
Practice Address - Country:US
Practice Address - Phone:231-845-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10255122300000X
MI17339122300000X
MI19317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty