Provider Demographics
NPI:1982054508
Name:LAKEWOOD DENTISTRY
Entity Type:Organization
Organization Name:LAKEWOOD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS-FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:281-320-0400
Mailing Address - Street 1:11550 LOUETTA RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1368
Mailing Address - Country:US
Mailing Address - Phone:281-320-0400
Mailing Address - Fax:281-320-9746
Practice Address - Street 1:11550 LOUETTA RD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1368
Practice Address - Country:US
Practice Address - Phone:281-320-0400
Practice Address - Fax:281-320-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty