NPIMap

Organization Active NPI

Lakeline Family Dental

  • Dentist
  • Cedar Park, TX
National Provider Identifier
1043612963
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22965 Issued in TX
Legal business name
LAKELINE FAMILY DENTAL
Practice address
1201 N Lakeline Blvd
Suite Number 300
Cedar Park, TX 78613-6781
Phone
(512) 937-3371
NPI assigned
Sep 23, 2014
Last updated
Sep 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Amita Prakash, DDSNPI 1659401115
Title
Dentist
Phone
(512) 659-6968

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 22965 TX Primary

Addresses

Primary practice location

1201 N Lakeline Blvd
Suite Number 300
Cedar Park, TX 78613-6781

Mailing address

1201 N Lakeline Blvd
Suite Number 300
Cedar Park, TX 78613-6781
Phone (512) 937-3371

Other identifiers 1

IdentifierTypeStateIssuer
183706402MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1043612963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 N LAKELINE BLVD",
            "address_2": "SUITE NUMBER 300",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786136781",
            "telephone_number": "512-937-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N LAKELINE BLVD",
            "address_2": "SUITE NUMBER 300",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786136781",
            "telephone_number": "512-937-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "PRAKASH",
        "authorized_official_first_name": "AMITA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "512-659-6968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "22965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183706402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.