Provider Demographics
NPI:1184103186
Name:L H DENTAL GROUP, PLLC
Entity type:Organization
Organization Name:L H DENTAL GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-262-9940
Mailing Address - Street 1:429 BONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2127
Mailing Address - Country:US
Mailing Address - Phone:214-649-3065
Mailing Address - Fax:
Practice Address - Street 1:14362 W STATE HIGHWAY 29 STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4238
Practice Address - Country:US
Practice Address - Phone:512-262-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty