# LAKE COUNTRY DENTAL

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

## Provider details

- **NPI number:** 1972692556
- **Authorized official:** DR. RAY D. SNIDER D.D.S., P.A. (OWNER/DENTIST)
- **Authorized official phone:** (817) 236-8771

## Contact information

- **Practice address:** 8461 BOAT CLUB RD, FORT WORTH, TX 76179-3607
- **Practice address phone:** (817) 236-8771
- **Practice address fax:** (817) 236-8791
- **Mailing address:** 8461 BOAT CLUB RD, FORT WORTH, TX 76179-3607
- **Mailing address phone:** (817) 236-8771
- **Mailing address fax:** (817) 236-8791

## Taxonomy

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

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 841904 | UNITED CONCORDIA \# | TX |
| 01 | — | D12073 | BC/BS PROVIDER \# | TX |