Organization
LAKESIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANPHAPHONE LINAVONG (DENTIST)
(972) 929-3092
Entity
Organization
Contact information
Practice address
407 W ELDORADO PKWY STE 140, LITTLE ELM, TX 75068-5086
(972) 292-3092
Mailing address
407 W ELDORADO PKWY STE 140, LITTLE ELM, TX 75068-5086
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/25/2006
Last updated
08/22/2020
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