Sd Park Lake Pllc

NPI #1164111241 in Waco, Texas

Provider Information

NPI Number: 1164111241
Entity Type: Organization
Organization Name: Sd Park Lake Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: May 3, 2023
Last Updated: May 3, 2023

Practice Location

Address: 1925 PARK LAKE DR
City: Waco
State: Texas
ZIP Code: 76708-1682
Phone: (254) 221-0999

Authorized Official

Name: DR. LYNHTHY T PHAM, DDS
Title: OWNER
Phone: (469) 902-6792

Specialties & Taxonomy Codes

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

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