| Lake Country Dental | |
|
8461 Boat Club Rd Fort Worth TX 76179-3607 | |
| (817) 236-8771 | |
| (817) 236-8791 |
| Full Name | Lake Country Dental |
|---|---|
| Speciality | Dentist |
| Location | 8461 Boat Club Rd, Fort Worth, Texas |
| Authorized Official Name and Position | Ray D. Snider (OWNER/DENTIST) |
| Authorized Official Contact | 8172368771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Country Dental 8461 Boat Club Rd Fort Worth TX 76179-3607 Ph: (817) 236-8771 | Lake Country Dental 8461 Boat Club Rd Fort Worth TX 76179-3607 Ph: (817) 236-8771 |
| NPI Number | 1972692556 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972692556 | NPI | - | NPPES |
| 841904 | Other | TX | UNITED CONCORDIA # |
| D12073 | Other | TX | BC/BS PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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