Lakeshore Family Dental Center LLC
NPI 1306629589ActiveOrganization· Dentist· Glendale, WI
Dentist in Glendale, Wisconsin, registered in NPPES in August 2023. The authorized official on file is Victoria Johnson, Cro.
Overview
| NPI | 1306629589 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 14, 2023 |
| Last updated in NPPES | Jul 21, 2026 |
| Certified by provider | Jul 21, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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