Lake Family and Cosmetic Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

25182 Issued in TX

Legal business name

LAKE FAMILY AND COSMETIC DENTISTRY

Practice address

4968 Overton Ridge Blvd
Fort Worth, TX 76132-1909

Phone

(817) 263-0181

NPI assigned

Jan 27, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly J Lake, DDSNPI 1366773517

Title

Owner/ President

Phone

(817) 263-0181

Specialties & licenses 1

Addresses

Other names 1

• Lake Family Dental Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly J Lake, DDS

  • General Practice Dentistry
  • Dallas, TX
  • NPI 1366773517
  NPD (past) Authorized official
• Steven M Huffstutler, DDS

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1528074754
  NPD (past)

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

{
    "created_epoch": "1390780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1073936084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4968 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761321909",
            "telephone_number": "817-263-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4968 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761321909",
            "telephone_number": "817-263-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FAMILY AND COSMETIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-27",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "817-263-0181",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "25182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brook Pritchard Laird, CRNA
• Stephanie Laird, PT, DPT
• Elizabeth Lakamp
• Lake Country Dental
• Lake Country Family Medicine, P.a.
• Lake Worth Center Dental PLLC
• Lake Worth Counseling
• Lake Worth Independent School District
• Lake Worth Investments Inc.
• Jeremy Michael Lake, PT

• Dentist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.