| NPI | 1841096799 |
|---|---|
| Doing Business As | DENTAL LAKE MARY |
| Entity Type | Organization |
| Authorized Contact | ERIKA MELISSA MENJIVAR Sr. Credentialing Specialist 469-596-6137 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |