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Organization

LAKE MEADOW DENTAL GROUP PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMANDA LIGHTFOOT (AUTHORIZED REPRESENTATIVE)
(214) 702-0708
Entity
Organization

Contact information

Practice address
9262 FOREST LN STE 100, DALLAS, TX 75243-6237
(214) 349-2160
Mailing address
15660 DALLAS PKWY STE 925, DALLAS, TX 75248-3323
(214) 702-0720

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11606
TX

Other

Enumeration date
03/16/2018
Last updated
05/09/2023
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