# LEISA ROBOTHAM-REID PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakewood Dental Studio
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689340192
- **Authorized official:** DR. LEISA ROBOTHAM-REID DDS (MANAGING MEMBER)
- **Authorized official phone:** (917) 873-2500

## Contact information

- **Practice address:** 6220 GASTON AVE STE 600, DALLAS, TX 75214-4345
- **Practice address phone:** (917) 873-2500
- **Mailing address:** 4419 CABELL DR APT 102, DALLAS, TX 75204-0001
- **Mailing address phone:** (917) 873-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/17/2021
- **Last updated:** 08/17/2021