# LAKE COUNTRY DENTAL

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

## Provider details

- **NPI number:** 1063751584
- **Authorized official:** DR. LISA MARTIN DDS (OWNER)
- **Authorized official phone:** (830) 201-2114

## Contact information

- **Practice address:** 7401 WEST FM 2147, SUITE 1, HORSESHOE BAY, TX 78657
- **Practice address phone:** (830) 201-2114
- **Mailing address:** PO BOX 4208, HORSESHOE BAY, TX 78657-4208
- **Mailing address phone:** (830) 201-2114
- **Mailing address fax:** (830) 549-2134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 24676 | TX | Yes |

## Other

- **Enumeration date:** 02/04/2013
- **Last updated:** 02/04/2013