| NPI | 1073936084 |
|---|---|
| Doing Business As | LAKE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY J LAKE Owner/ President 817-263-0181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25182) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2014-01-27 |