Provider Demographics
NPI:1538480850
Name:LANCASTER DENTAL LLC
Entity Type:Organization
Organization Name:LANCASTER DENTAL LLC
Other - Org Name:LANCASTER DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD RAGHID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:469-387-6853
Mailing Address - Street 1:1450 W PLEASANT RUN RD
Mailing Address - Street 2:STE 114
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-3741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 W PLEASANT RUN RD
Practice Address - Street 2:STE 114
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-3741
Practice Address - Country:US
Practice Address - Phone:972-227-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252221223G0001X
TX241851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty