Lake Shore Dental Group PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKE SHORE DENTAL GROUP PLLC

Practice address

4535 Lake Shore Dr
Waco, TX 76710

Phone

(254) 776-7622

Fax

(254) 776-7673

NPI assigned

Oct 4, 2021

Organization subpart

Yes

Parent organization

BRIGHT DENTAL ASSOCIATES LLCAs reported in NPPES

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

Authorized official

Name

Traci Waldschmidt

Title

Chief Operating Officer

Phone

(254) 722-1083

Specialties & licenses 1

Addresses

Other names 1

• Bright Dental Associates LLC Other name

Practitioners 1

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

• Thomas Wilson Waggener, D.D.S.

  • General Practice Dentistry
  • Waco, TX
  • NPI 1629166798

  General Practice

  NPD (past)

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1093487555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101814",
            "telephone_number": "254-776-7622",
            "fax_number": "254-776-7673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4535 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76710",
            "telephone_number": "254-776-7622",
            "fax_number": "254-776-7673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE DENTAL GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIGHT DENTAL ASSOCIATES LLC",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "WALDSCHMIDT",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "254-722-1083"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Dental Associates LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Juan Romero Lagunas Jr., PHARMD
• Tommy Wayne Laird Jr., PA-C
• Lake Shore Center for Behavioral Health, LLC
• Lake Shore Center for Psychological Services, P.C.
• Lake Shore Dental Care, PLLC
• Lake Shore Family Medicine, P.a.
• Jamie Lynn Lambert, PAC
• Manita Lamichhane, NURSE PRACTITIONER
• Kayla Lammert, DDS
• Landmark Chiropractic LLC

• All providers in Waco, TX
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; 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.