Provider Demographics
NPI:1649328329
Name:LAKE HIGHLANDS DENTAL
Entity type:Organization
Organization Name:LAKE HIGHLANDS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDEL
Authorized Official - Middle Name:CATES
Authorized Official - Last Name:STRIPLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-343-9282
Mailing Address - Street 1:8610 GREENVILLE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7159
Mailing Address - Country:US
Mailing Address - Phone:214-343-9280
Mailing Address - Fax:214-348-1909
Practice Address - Street 1:8610 GREENVILLE AVE STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7159
Practice Address - Country:US
Practice Address - Phone:214-343-9280
Practice Address - Fax:214-348-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicare UPIN