Kimberly J Lake, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25182 Issued in TX

Practice address

3434 W Illinois Ave
Ste 307
Dallas, TX 75211-8709

Phone

(817) 689-8656

NPI assigned

Jan 27, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake Family and Cosmetic Dentistry

  dba Lake Family Dental

  • Dentist
  • Fort Worth, TX
  • NPI 1073936084
  NPD (past) Authorized official

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

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1366773517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 W ERIE ST",
            "address_2": "STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 W ILLINOIS AVE",
            "address_2": "STE 307",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752118709",
            "telephone_number": "817-689-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-27",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake June Medical Center, P.a.
• Lake June SRGM PLLC
• Lake Meadow Dental Group PLLC
• Lake Time Crna
• Amy Lake
• Lakehill Preparatory School: Health and Wellness Center
• Lakeshia Kijuan Ealy (Gentle Hands Home Health Care)
• Lakeshore Anesthesia Group, PLLC
• Lakeshore Healthcare Services, Inc.
• Lakeshore Medical Supplies, Inc.

• General Practice Dentistry in Dallas, TX
• Providers in Dallas, 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 Oct 30, 2012; 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.