Provider Demographics
NPI:1437304128
Name:HOME TOWN DENTAL OF LAKE WORTH PC
Entity Type:Organization
Organization Name:HOME TOWN DENTAL OF LAKE WORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-927-8500
Mailing Address - Street 1:6332 LAKE WORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3602
Mailing Address - Country:US
Mailing Address - Phone:817-237-3222
Mailing Address - Fax:817-237-0101
Practice Address - Street 1:6332 LAKE WORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3602
Practice Address - Country:US
Practice Address - Phone:817-237-3222
Practice Address - Fax:817-237-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty