| Organization Name: | LAKEVIEW DENTAL CLINIC |
| NPI Number: | 1255790861 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHUNG HAO TSEN (GENERAL DENTIST) |
| Mailing Address: | 9421 N Davies Rd Lake Stevens |
| State: | WA US |
| Postal Code: | 982589444 |
| Phone Number: | 4253342900 |
| Fax Number: | 4253346958 |
| NPI Enumeration Date: | 02/11/2016 |
| NPI Last Update Date: | 03/27/2016 |
| 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: | |