Lol Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LOL DENTAL

Practice address

1501 E Loop 304
Suite 100
Crockett, TX 75835-3417

Phone

(314) 477-2752

NPI assigned

May 16, 2012

Organization subpart

No

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

Authorized official

Name

Sherif A Warda, DDS

Title

Owner

Phone

(314) 477-2752

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395878400000",
    "number": "1235499807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 MELROSE AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911051426",
            "telephone_number": "310-806-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E LOOP 304",
            "address_2": "SUITE 100",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758353417",
            "telephone_number": "314-477-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOL DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-16",
        "last_updated": "2014-03-27",
        "status": "A",
        "authorized_official_last_name": "WARDA",
        "authorized_official_first_name": "SHERIF",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-477-2752",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ravi Konidala, MD
• Mary Krug, CCC-SLP
• Brooke Alison Kuza, M.S., CCC-SLP
• Lifeguard Ambulance Service of Texas, LLC
• Meagan Linton-Defrance, MSN, APRN, FNP-C
• Lusso Laboratory LLC
• Amber Breanna Manning, RN
• James Jeffrey Martin, R.PH.
• Judy Carole Martin, RPH
• Mary Martin

• General Practice Dentistry in Crockett, TX
• Providers in Crockett, TX by specialty
• General Practice Dentistry in Texas

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