| NPI | 1184389355 |
|---|---|
| Former Legal Business Name | FULL SMILE DENTAL LAKERIDGE, PLLC |
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN MORRIS Credentialing Specialist 806-353-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| 1223E0200X Dentist, Endodontics | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-02-24 |