| Organization Name: | LAKESIDE DENTAL, INC. |
| NPI Number: | 1205018033 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL F. CALITRI (PRESIDENT) |
| Mailing Address: | 34 Nooseneck Hill Rd Unit #1 West Greenwich |
| State: | RI US |
| Postal Code: | 028171509 |
| Phone Number: | 4013923320 |
| Fax Number: | 4013923380 |
| NPI Enumeration Date: | 12/04/2007 |
| NPI Last Update Date: | 08/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |