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Organization
FULL SMILE DENTAL LAKERIDGE, PLLC
Active
Organization
FULL SMILE DENTAL LAKERIDGE, PLLC
Active
Other names
Full Smile Dental Lakeridge, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN MORRIS (CREDENTIALING SPECIALIST)
(806) 353-1055
Entity
Organization
Contact information
Practice address
4425 98TH ST, LUBBOCK, TX 79424-5029
(806) 641-1373
(806) 353-7077
Mailing address
5051 S SONCY RD, AMARILLO, TX 79119-6667
(806) 353-1055
(806) 353-7077
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/03/2021
Last updated
02/24/2022
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