Provider Demographics
NPI:1003111295
Name:LAKE POINTE DENTAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:LAKE POINTE DENTAL ASSOCIATES, PA
Other - Org Name:LAKE POINTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-263-7896
Mailing Address - Street 1:11612 FM 2244
Mailing Address - Street 2:BUILDING 2, SUITE 155
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5409
Mailing Address - Country:US
Mailing Address - Phone:512-263-7896
Mailing Address - Fax:512-263-8005
Practice Address - Street 1:11612 FM 2244
Practice Address - Street 2:BUILDING 2, SUITE 155
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5409
Practice Address - Country:US
Practice Address - Phone:512-263-7896
Practice Address - Fax:512-263-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22902261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental