| Lakeline Mall Family Dental | |
|
11200 Lakeline Mall Dr #b1 Cedar Park TX 78613-1501 | |
| (512) 448-4867 | |
| (512) 335-7668 |
| Full Name | Lakeline Mall Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11200 Lakeline Mall Dr, Cedar Park, Texas |
| Authorized Official Name and Position | Beau D Blankenship (OWNER/PRESIDENT) |
| Authorized Official Contact | 2107229274 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeline Mall Family Dental 1215 Sledge Dr Austin TX 78734-6373 Ph: (210) 722-9274 | Lakeline Mall Family Dental 11200 Lakeline Mall Dr #b1 Cedar Park TX 78613-1501 Ph: (512) 448-4867 |
| NPI Number | 1104190594 |
|---|---|
| Provider Enumeration Date | 03/01/2012 |
| Last Update Date | 03/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104190594 | NPI | - | NPPES |
| 181540911 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 22816 (Texas) | Primary |
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Lakeline Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1201 N Lakeline Blvd, Suite Number 300, Cedar Park, TX 78613 Phone: 512-937-3371 | |
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Walden Dental Cedar Park Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5001 183a Toll Rd, Suite R300, Cedar Park, TX 78613 Phone: 512-362-7130 Fax: 512-362-7132 | |
Dentistry For The Elderly, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 Cripple Creek Rd, Cedar Park, TX 78613 Phone: 143-436-1452 Fax: 888-316-6432 |