Provider Demographics
NPI:1295846228
Name:LAKE POINTE DENTAL INC
Entity Type:Organization
Organization Name:LAKE POINTE DENTAL INC
Other - Org Name:LAKE POINTE DENTAL MARIETTA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARFOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-872-0548
Mailing Address - Street 1:1880 W OAK PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2272
Mailing Address - Country:US
Mailing Address - Phone:770-514-0440
Mailing Address - Fax:770-514-0442
Practice Address - Street 1:1880 W OAK PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2272
Practice Address - Country:US
Practice Address - Phone:770-514-0440
Practice Address - Fax:770-514-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty