| Sd Park Lake Pllc | |
|
1925 Park Lake Dr Waco TX 76708-1682 | |
| (254) 221-0999 | |
| Not Available |
| Full Name | Sd Park Lake Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1925 Park Lake Dr, Waco, Texas |
| Authorized Official Name and Position | Lynhthy T Pham (OWNER) |
| Authorized Official Contact | 4699026792 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sd Park Lake Pllc Po Box 453247 Garland TX 75045-3247 Ph: (214) 466-1400 | Sd Park Lake Pllc 1925 Park Lake Dr Waco TX 76708-1682 Ph: (254) 221-0999 |
| NPI Number | 1164111241 |
|---|---|
| Provider Enumeration Date | 05/03/2023 |
| Last Update Date | 05/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164111241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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