Lakeline Mall Family Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

LAKELINE MALL FAMILY DENTAL

Practice address

11200 Lakeline Mall Dr
Suite B01
Cedar Park, TX 78613-1501

Phone

(214) 390-9948

NPI assigned

Jul 23, 2013

Organization subpart

No

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

Authorized official

Name

Justin Cordon

Title

Manager

Phone

(214) 390-9948

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1053753764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "SUITE B01",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "SUITE B01",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131501",
            "telephone_number": "214-390-9948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE MALL FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "CORDON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-390-9948"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeline Emergency Center, LLC
• Lakeline Emergency Physicians, PLLC
• Lakeline Eye Center
• Lakeline Eyecare PLLC
• Lakeline Family Dental
• Lakeline Mall FDC PA
• Lakeline Medical Supply
• Lakeline Outpatient Care PLLC
• Lakeline Vision, P.C.
• Catherine Lambert, MA, LPCA

• Dentist in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.