| Lakeline Family Dental | |
|
1201 N Lakeline Blvd Suite Number 300 Cedar Park TX 78613-6781 | |
| (512) 937-3371 | |
| Not Available |
| Full Name | Lakeline Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 1201 N Lakeline Blvd, Cedar Park, Texas |
| Authorized Official Name and Position | Amita Prakash (DENTIST) |
| Authorized Official Contact | 5126596968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeline Family Dental 1201 N Lakeline Blvd Suite Number 300 Cedar Park TX 78613-6781 Ph: (512) 937-3371 | Lakeline Family Dental 1201 N Lakeline Blvd Suite Number 300 Cedar Park TX 78613-6781 Ph: (512) 937-3371 |
| NPI Number | 1043612963 |
|---|---|
| Provider Enumeration Date | 09/23/2014 |
| Last Update Date | 09/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043612963 | NPI | - | NPPES |
| 183706402 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22965 (Texas) | Primary |
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