Provider Demographics
NPI:1699953349
Name:LAKE VIEW DENTAL CENTER
Entity type:Organization
Organization Name:LAKE VIEW DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-569-5569
Mailing Address - Street 1:1800 S PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-2800
Mailing Address - Country:US
Mailing Address - Phone:903-569-5569
Mailing Address - Fax:903-569-1601
Practice Address - Street 1:1800 S PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-2800
Practice Address - Country:US
Practice Address - Phone:903-569-5569
Practice Address - Fax:903-569-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental