Provider Demographics
NPI:1811871197
Name:LAKE BREEZE DENTAL, LLC
Entity type:Organization
Organization Name:LAKE BREEZE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PASONO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-639-1215
Mailing Address - Street 1:379 CLERMONT CT
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4075
Mailing Address - Country:US
Mailing Address - Phone:920-639-1215
Mailing Address - Fax:
Practice Address - Street 1:3712 KADOW ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5450
Practice Address - Country:US
Practice Address - Phone:920-684-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PEARL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental