# LAKELINE FAMILY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043612963
- **Authorized official:** DR. AMITA PRAKASH DDS (DENTIST)
- **Authorized official phone:** (512) 659-6968

## Contact information

- **Practice address:** 1201 N LAKELINE BLVD, SUITE NUMBER 300, CEDAR PARK, TX 78613-6781
- **Practice address phone:** (512) 937-3371
- **Mailing address:** 1201 N LAKELINE BLVD, SUITE NUMBER 300, CEDAR PARK, TX 78613-6781
- **Mailing address phone:** (512) 937-3371

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22965 | TX | Yes |

## Other

- **Enumeration date:** 09/23/2014
- **Last updated:** 09/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 183706402 | — | TX |