Provider Demographics
NPI:1538336474
Name:LAKEVIEW DENTAL
Entity type:Organization
Organization Name:LAKEVIEW DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:AFAF
Authorized Official - Middle Name:EZZAT
Authorized Official - Last Name:ISKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-437-4426
Mailing Address - Street 1:709 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:626-797-8900
Mailing Address - Fax:626-797-8900
Practice Address - Street 1:709 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:626-797-8900
Practice Address - Fax:626-797-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty