Lake Family and Cosmetic Dentistry

NPI #1073936084 in Fort Worth, Texas

Provider Information

NPI Number: 1073936084
Entity Type: Organization
Organization Name: Lake Family and Cosmetic Dentistry
Primary Specialty: Dentist
Enumeration Date: Jan 27, 2014
Last Updated: Jan 27, 2014

Practice Location

Address: 4968 OVERTON RIDGE BLVD
City: Fort Worth
State: Texas
ZIP Code: 76132-1909
Phone: (817) 263-0181

Authorized Official

Name: DR. KIMBERLY J LAKE, DDS
Title: OWNER/ PRESIDENT
Phone: (817) 263-0181

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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