| Lake Shore Dental Group Pllc | |
|
4535 Lake Shore Dr Waco TX 76710 | |
| (254) 776-7622 | |
| (254) 776-7673 |
| Full Name | Lake Shore Dental Group Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4535 Lake Shore Dr, Waco, Texas |
| Authorized Official Name and Position | Traci Waldschmidt (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2547221083 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Shore Dental Group Pllc 4535 Lake Shore Dr Waco TX 76710-1814 Ph: (254) 776-7622 | Lake Shore Dental Group Pllc 4535 Lake Shore Dr Waco TX 76710 Ph: (254) 776-7622 |
| NPI Number | 1093487555 |
|---|---|
| Provider Enumeration Date | 10/04/2021 |
| Last Update Date | 10/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093487555 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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