Provider Demographics
NPI:1215493408
Name:LAKEWOOD KIDS DENTISTRY, PLLC
Entity type:Organization
Organization Name:LAKEWOOD KIDS DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON-HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:832-654-6641
Mailing Address - Street 1:11550 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1368
Mailing Address - Country:US
Mailing Address - Phone:832-654-6641
Mailing Address - Fax:
Practice Address - Street 1:11550 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1368
Practice Address - Country:US
Practice Address - Phone:832-654-6641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518198480OtherNPI