# LAKE JUNE SRGM PLLC

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

## Provider details

- **NPI number:** 1871187468
- **Authorized official:** NINA ABTAHI (MANAGER)
- **Authorized official phone:** (214) 493-1216

## Contact information

- **Practice address:** 10025 LAKE JUNE RD \# B, DALLAS, TX 75217-3041
- **Practice address phone:** (214) 493-1216
- **Mailing address:** 10025 LAKE JUNE RD \# B, DALLAS, TX 75217-3041
- **Mailing address phone:** (214) 493-1216

## Taxonomy

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

## Other

- **Enumeration date:** 02/24/2021
- **Last updated:** 02/24/2021