Provider Demographics
NPI:1093944241
Name:LEANDER SMILES DENTISTRY
Entity Type:Organization
Organization Name:LEANDER SMILES DENTISTRY
Other - Org Name:LAKELINE MALL DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-260-0123
Mailing Address - Street 1:651 N US HIGHWAY 183
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-8990
Mailing Address - Country:US
Mailing Address - Phone:512-260-0123
Mailing Address - Fax:512-260-0110
Practice Address - Street 1:651 N US HIGHWAY 183
Practice Address - Street 2:SUITE 150
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-8990
Practice Address - Country:US
Practice Address - Phone:512-260-0123
Practice Address - Fax:512-260-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty