| NPI | 1447595855 |
|---|---|
| Doing Business As | LAKELINE RISING STARS PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY B GREGERSON Owner 512-266-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2015-03-17 |