Provider Demographics
NPI:1285114249
Name:LAKESIDE DENTAL SLEEP ASSOCIATES LLC
Entity type:Organization
Organization Name:LAKESIDE DENTAL SLEEP ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIRUTE-PRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:972-412-0014
Mailing Address - Street 1:6705 HERITAGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8728
Mailing Address - Country:US
Mailing Address - Phone:844-695-7533
Mailing Address - Fax:
Practice Address - Street 1:6705 HERITAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8728
Practice Address - Country:US
Practice Address - Phone:844-695-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment