Provider Demographics
NPI:1639876642
Name:LAKE OLYMPIA DENTAL
Entity Type:Organization
Organization Name:LAKE OLYMPIA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-444-9861
Mailing Address - Street 1:2000 TAYLOR ST APT 421
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4567
Mailing Address - Country:US
Mailing Address - Phone:260-444-9861
Mailing Address - Fax:
Practice Address - Street 1:1021 LAKE OLYMPIA PKWY STE 800
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5449
Practice Address - Country:US
Practice Address - Phone:281-848-8822
Practice Address - Fax:281-843-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty