| Organization Name: | NORTH LAKE FAMILY DENTISTRY |
| NPI Number: | 1366840456 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATTY R ERICKSON (OWNER) |
| Mailing Address: | W315n7641 Hwy 83 Hartland |
| State: | WI US |
| Postal Code: | 530299759 |
| Phone Number: | 2629667668 |
| Fax Number: | |
| NPI Enumeration Date: | 12/05/2014 |
| NPI Last Update Date: | 12/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 6346 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |