| NPI | 1083940340 |
|---|---|
| Doing Business As | LAKEWAY PERIODONTICS |
| Entity Type | Organization |
| Authorized Contact | SASI K MANNEM Owner 512-402-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 19578) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2009-10-21 |