Provider Demographics
NPI:1043301435
Name:LAKEPOINTE DENTAL
Entity Type:Organization
Organization Name:LAKEPOINTE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINAVONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-633-9925
Mailing Address - Street 1:279 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4307
Mailing Address - Country:US
Mailing Address - Phone:469-633-9925
Mailing Address - Fax:
Practice Address - Street 1:279 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4307
Practice Address - Country:US
Practice Address - Phone:469-633-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty