| Katy Lakes Dentistry | |
|
23927 Fm 529 Suite 150 Katy TX 77493 | |
| (832) 913-1772 | |
| (832) 913-5462 |
| Full Name | Katy Lakes Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 23927 Fm 529, Katy, Texas |
| Authorized Official Name and Position | Bowen Li (MANAGER) |
| Authorized Official Contact | 7168609415 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Katy Lakes Dentistry 1623 Gingerleaf Ln Houston TX 77055-3409 Ph: (832) 409-4949 | Katy Lakes Dentistry 23927 Fm 529 Suite 150 Katy TX 77493 Ph: (832) 913-1772 |
| NPI Number | 1750088746 |
|---|---|
| Provider Enumeration Date | 02/10/2023 |
| Last Update Date | 03/28/2023 |
| Certification Date | 03/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750088746 | NPI | - | NPPES |
| 3179087 | Medicaid | TX | |
| 2013013 | Medicaid | TX | |
| 4114589 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Secondary |
| 122300000X | Dentist | (NU) | Primary |
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