Lake Country Dental

Primary specialty

DentistTaxonomy code 122300000X

License

24676 Issued in TX

Legal business name

LAKE COUNTRY DENTAL

Practice address

7401 West FM 2147
Suite 1
Horseshoe Bay, TX 78657

Phone

(830) 201-2114

NPI assigned

Feb 4, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Martin, DDS

Title

Owner

Phone

(830) 201-2114

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359936000000",
    "number": "1063751584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4208",
            "city": "HORSESHOE BAY",
            "state": "TX",
            "postal_code": "786574208",
            "telephone_number": "830-201-2114",
            "fax_number": "830-549-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 WEST FM 2147",
            "address_2": "SUITE 1",
            "city": "HORSESHOE BAY",
            "state": "TX",
            "postal_code": "78657",
            "telephone_number": "830-201-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-04",
        "last_updated": "2013-02-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-201-2114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "24676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Llano County Hospital Authority
• LLV1 LP
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• Larry G. Manning, M.D.
• Teresa J Miller, APN, CNS

• Dentist in Horseshoe Bay, TX
• Providers in Horseshoe Bay, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 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.