Organization
LAKE SHORE DENTAL CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW HALFMANN DDS (OWNER DENTIST)
(254) 709-0514
Entity
Organization
Contact information
Practice address
4535 LAKE SHORE DR, WACO, TX 76710-1814
(254) 414-0928
Mailing address
4535 LAKE SHORE DR, WACO, TX 76710-1814
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528684412
NPI
—
01
—
1700922812
NPI
TX
01
—
1972236081
NPI
TX
Enumeration date
07/29/2025
Last updated
07/29/2025
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