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General NPI Number Information
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NPI Number | 1336759596
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Entity Type | Organization
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Legal Business Name | LAKEWOOD HILLS DENTAL, PLLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 4730 WINDHAVEN PKWY STE 120
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City | LEWISVILLE
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State | TX
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Zip | 75056-6703
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Country | US
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Telephone | 469-294-0292
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Fax |
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Provider Business Mailing Address
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Address Line | 3043 OLD DENTON RD STE 108
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City | CARROLLTON
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State | TX
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Zip | 75007-5004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TUAN SU
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Credential | DDS
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Telephone | 972-839-2873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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