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LAKEVIEW DENTAL

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Company Details

Name: LAKEVIEW DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 16 Feb 2010 (16 years ago)
Entity Number: 417924
Place of Formation: IDAHO
File Number: 0000417924
ZIP code: 83814
County: Kootenai County
Mailing Address: 801 N MILWAUKEE COEUR D'ALENE, ID 83814

National Provider Identifier

NPI Number:
1801241922

Authorized Person:

Name:
DR. SPENCER WIRIG
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
332BC3200X - Customized Equipment (DME)
Is Primary:
No
Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

Fax:
2086643304

Filing

Filing Name Filing Number Filing date
Initial Filing 0000417924 2010-02-16

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State