Lake Shore Dental Group Pllc

NPI #1093487555 in Waco, Texas

Provider Information

NPI Number: 1093487555
Entity Type: Organization
Organization Name: Lake Shore Dental Group Pllc
Subpart: Yes (part of a larger organization)
Parent Organization: BRIGHT DENTAL ASSOCIATES LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 4, 2021
Last Updated: Oct 4, 2021

Practice Location

Address: 4535 LAKE SHORE DR
City: Waco
State: Texas
ZIP Code: 76710
Phone: (254) 776-7622

Authorized Official

Name: TRACI WALDSCHMIDT
Title: CHIEF OPERATING OFFICER
Phone: (254) 722-1083

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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