# LAKEVIEW MOBILE DENTAL SERVICES, PLLC

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

## Provider details

- **NPI number:** 1295132488
- **Authorized official:** REJI MATHEW DDS (MEMBER)
- **Authorized official phone:** (469) 675-3890

## Contact information

- **Practice address:** 1505 W MCDERMOTT DR, STE 200, ALLEN, TX 75013-4692
- **Practice address phone:** (469) 675-3890
- **Practice address fax:** (469) 675-3893
- **Mailing address:** 1505 W MCDERMOTT DR, STE 200, ALLEN, TX 75013-4692
- **Mailing address phone:** (469) 675-3890
- **Mailing address fax:** (469) 675-3893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 23355 | TX | Yes |

## Other

- **Enumeration date:** 12/03/2014
- **Last updated:** 12/03/2014