Organization
LAKEVIEW MOBILE DENTAL SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REJI MATHEW DDS (MEMBER)
(469) 675-3890
Entity
Organization
Contact information
Practice address
1505 W MCDERMOTT DR, STE 200, ALLEN, TX 75013-4692
(469) 675-3890
(469) 675-3893
Mailing address
1505 W MCDERMOTT DR, STE 200, ALLEN, TX 75013-4692
(469) 675-3890
(469) 675-3893
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
23355
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23355
DENTAL LICENSE
TX
Enumeration date
12/03/2014
Last updated
12/03/2014
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