| Lake Family Dental | |
|
4968 Overton Ridge Blvd Fort Worth TX 76132-1909 | |
| (817) 263-0181 | |
| Not Available |
| Full Name | Lake Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 4968 Overton Ridge Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Kimberly J Lake (OWNER/ PRESIDENT) |
| Authorized Official Contact | 8172630181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Family Dental 4968 Overton Ridge Blvd Fort Worth TX 76132-1909 Ph: (817) 263-0181 | Lake Family Dental 4968 Overton Ridge Blvd Fort Worth TX 76132-1909 Ph: (817) 263-0181 |
| NPI Number | 1073936084 |
|---|---|
| Provider Enumeration Date | 01/27/2014 |
| Last Update Date | 01/27/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073936084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 25182 (Texas) | Primary |
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