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General NPI Number Information
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NPI Number | 1568158376
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Entity Type | Organization
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Legal Business Name | LB DENTAL PLLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 1616 FM 685 STE 103
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-7537
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Country | US
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Telephone | 512-273-7790
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Fax |
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Provider Business Mailing Address
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Address Line | 2853 CROCKETT ST APT 513
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City | FORT WORTH
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State | TX
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Zip | 76107-2999
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Country | US
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Telephone | 317-937-9408
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LAKSHAY BHARDWAJ
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Credential | DDS
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Telephone | 317-937-9408
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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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