Provider Demographics
NPI:1992393185
Name:LAKECREEK FAMILY DENTAL
Entity type:Organization
Organization Name:LAKECREEK FAMILY DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITI
Authorized Official - Middle Name:RAJESH
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-290-6561
Mailing Address - Street 1:3456 FRANCISCO WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2169
Mailing Address - Country:US
Mailing Address - Phone:254-290-6561
Mailing Address - Fax:
Practice Address - Street 1:10125 LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1711
Practice Address - Country:US
Practice Address - Phone:512-331-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental