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General NPI Number Information
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NPI Number | 1487056099
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Entity Type | Organization
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Legal Business Name | LAMESA DENTAL, PC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 311 N DALLAS AVE
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City | LAMESA
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State | TX
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Zip | 79331-5519
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Country | US
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Telephone | 415-505-6970
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Fax |
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Provider Business Mailing Address
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Address Line | 311 N DALLAS AVE
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City | LAMESA
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State | TX
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Zip | 79331-5519
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Country | US
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Telephone | 415-505-6970
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Fax |
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. PREET SANDHU
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Credential | DDS
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Telephone | 415-505-6970
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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 | 28249
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License Number State | TX
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