Provider Demographics
NPI:1487678967
Name:LUMBERTON DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:LUMBERTON DENTAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-755-4444
Mailing Address - Street 1:PO BOX 8239
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-0239
Mailing Address - Country:US
Mailing Address - Phone:409-755-4444
Mailing Address - Fax:409-755-3666
Practice Address - Street 1:120 COUNTRY LANE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-6802
Practice Address - Country:US
Practice Address - Phone:409-755-4444
Practice Address - Fax:409-755-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty