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General NPI Number Information
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NPI Number | 1467609404
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Entity Type | Organization
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Legal Business Name | LAKE POINTE DENTAL AND SPECIALTY
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 1437 HIGHWAY 6 SOUTH SUITE 200
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City | SUGARLAND
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State | TX
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Zip | 77479-3989
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Country | US
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Telephone | 281-242-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 4635 SOUTHWEST FWY SUITE 700
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City | HOUSTON
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State | TX
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Zip | 77027-7169
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Country | US
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Telephone | 281-242-4433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AYEEZ A LALJI
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Credential | D.D.S.
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Telephone | 281-242-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21114
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20007
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20305
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16917
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License Number State | TX
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