Organization
FULL SMILE DENTAL LAKERIDGE, PLLC
Active
Other names
Full Smile Dental Lakeridge, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN MORRIS (CREDENTIALING SPECIALIST)
(806) 353-1055
Entity
Organization
Contact information
Practice address
4425 98TH ST, LUBBOCK, TX 79424-5029
(806) 641-1373
(806) 353-7077
Mailing address
5051 S SONCY RD, AMARILLO, TX 79119-6667
(806) 353-1055
(806) 353-7077
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/03/2021
Last updated
02/24/2022
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