Lakeline Mall Family Dental

NPI #1053753764 in Cedar Park, Texas

Provider Information

NPI Number: 1053753764
Entity Type: Organization
Organization Name: Lakeline Mall Family Dental
Primary Specialty: Dentist
Enumeration Date: Jul 23, 2013
Last Updated: Jul 23, 2013

Practice Location

Address: 11200 LAKELINE MALL DR
Address 2: SUITE B01
City: Cedar Park
State: Texas
ZIP Code: 78613-1501
Phone: (214) 390-9948

Authorized Official

Name: JUSTIN CORDON
Title: MANAGER
Phone: (214) 390-9948

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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