Lakeline Mall FDC PA

Primary specialty

DentistTaxonomy code 122300000X

License

0008481 Issued in TX

Legal business name

LAKELINE MALL FDC PA

Practice address

11200 Lakeline Mall Dr
Ste B1
Cedar Park, TX 78613-1502

Phone

(512) 448-4867

Fax

(512) 335-7668

NPI assigned

May 23, 2008

Organization subpart

No

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

Authorized official

Name

Lynn Armstrong

Title

Regional Manager

Phone

(505) 328-4857

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1275791410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "STE B1",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131502",
            "telephone_number": "512-448-4867",
            "fax_number": "512-335-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 LAKELINE MALL DR",
            "address_2": "STE B1",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786131502",
            "telephone_number": "512-448-4867",
            "fax_number": "512-335-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELINE MALL FDC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "505-328-4857"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "0008481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeline Emergency Physicians, PLLC
• Lakeline Eye Center
• Lakeline Eyecare PLLC
• Lakeline Family Dental
• Lakeline Mall Family Dental
• Lakeline Medical Supply
• Lakeline Outpatient Care PLLC
• Lakeline Vision, P.C.
• Catherine Lambert, MA, LPCA
• Monica Lane, FNP-BC

• 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 May 23, 2008; 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.