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Organization

LAKE FAMILY AND COSMETIC DENTISTRY

Active
Other names
Lake Family Dental
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KIMBERLY J LAKE DDS (OWNER/ PRESIDENT)
(817) 263-0181
Entity
Organization

Contact information

Practice address
4968 OVERTON RIDGE BLVD, FORT WORTH, TX 76132-1909
(817) 263-0181
Mailing address
4968 OVERTON RIDGE BLVD, FORT WORTH, TX 76132-1909
(817) 263-0181

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25182
TX

Other

Enumeration date
01/27/2014
Last updated
01/27/2014
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