Provider Demographics
NPI:1568158376
Name:LB DENTAL PLLC
Entity Type:Organization
Organization Name:LB DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARDWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-937-9408
Mailing Address - Street 1:2853 CROCKETT ST APT 513
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2999
Mailing Address - Country:US
Mailing Address - Phone:317-937-9408
Mailing Address - Fax:
Practice Address - Street 1:1616 FM 685 STE 103
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7537
Practice Address - Country:US
Practice Address - Phone:512-273-7790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty