Provider Demographics
NPI:1922541416
Name:LAKELAND HEALTHCARE MANAGEMENT
Entity Type:Organization
Organization Name:LAKELAND HEALTHCARE MANAGEMENT
Other - Org Name:LAKELAND DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-400-0380
Mailing Address - Street 1:PO BOX 292114
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2548 LILLIAN MILLER PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:817-400-0380
Practice Address - Fax:972-947-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental