Organization
LAKEVIEW DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WYATT O'GRADY DDS (OWNER/DENTIST)
(817) 573-3724
Entity
Organization
Contact information
Practice address
1309 PALUXY RD, GRANBURY, TX 76048-5663
(817) 573-3724
(817) 573-9251
Mailing address
1309 PALUXY RD, GRANBURY, TX 76048-5663
(817) 573-3724
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
32086
TX
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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