Organization
LAKE COUNTRY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA MARTIN DDS (OWNER)
(830) 201-2114
Entity
Organization
Contact information
Practice address
7401 WEST FM 2147, SUITE 1, HORSESHOE BAY, TX 78657
(830) 201-2114
Mailing address
PO BOX 4208, HORSESHOE BAY, TX 78657-4208
(830) 201-2114
(830) 549-2134
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24676
TX
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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