Organization
LAKE COUNTRY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAY D. SNIDER D.D.S., P.A. (OWNER/DENTIST)
(817) 236-8771
Entity
Organization
Contact information
Practice address
8461 BOAT CLUB RD, FORT WORTH, TX 76179-3607
(817) 236-8771
(817) 236-8791
Mailing address
8461 BOAT CLUB RD, FORT WORTH, TX 76179-3607
(817) 236-8771
(817) 236-8791
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
841904
UNITED CONCORDIA #
TX
01
—
D12073
BC/BS PROVIDER #
TX
Enumeration date
10/12/2006
Last updated
08/22/2020
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