Healthcare Provider Details

I. General information

NPI: 1194494773
Provider Name (Legal Business Name): LFD DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 S LANCASTER RD STE 2275
DALLAS TX
75216-7278
US

IV. Provider business mailing address

2401 E RANDOL MILL RD STE 520
ARLINGTON TX
76011-6380
US

V. Phone/Fax

Practice location:
  • Phone: 469-620-7445
  • Fax: 469-607-9229
Mailing address:
  • Phone: 817-809-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. TEE SEMERA
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 469-556-9000