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General NPI Number Information
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NPI Number | 1548187974
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Entity Type | Organization
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Legal Business Name | PERSEUS DENTAL
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 550 W ROUND GROVE RD STE 950
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City | LEWISVILLE
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State | TX
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Zip | 75067-1233
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Country | US
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Telephone | 832-492-6567
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Fax |
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Provider Business Mailing Address
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Address Line | 412 BELMONT CT
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City | LEWISVILLE
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State | TX
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Zip | 75067-7906
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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 | OWNER
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Name | LARA KELLOGG
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Credential |
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Telephone | 832-492-6567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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