Lakeside Family Dentistry and TMJ, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKESIDE FAMILY DENTISTRY AND TMJ, PC

Practice address

7270 N Lake Dr Ste 100
Columbus, GA 31909-2764

Phone

(706) 323-6491

Fax

(706) 323-2671

NPI assigned

Oct 17, 2006

Last updated

Sep 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Phillip Shelby Tully III, DMDNPI 1578643920

Title

President

Phone

(706) 323-6491

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip Shelby Tully III, DMD

  • General Practice Dentistry
  • Columbus, GA
  • NPI 1578643920
  NPD Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1396825667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7270 N LAKE DR STE 100",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319092764",
            "telephone_number": "706-323-6491",
            "fax_number": "706-323-2671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7270 N LAKE DR STE 100",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319092764",
            "telephone_number": "706-323-6491",
            "fax_number": "706-323-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY DENTISTRY AND TMJ, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "TULLY",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "SHELBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-323-6491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rakeshia Lashae Lafavor
• Angela Lagrand
• Latanya Lagrand
• William Robert Lahouse, M.D.
• Dionna Lakes, PP, BS
• Naureen Lalani, PHARM.D.
• Linda Honekamp Lamb, PT
• Kylee Ann Lamberson
• Alexandria Lamont, APC, NCC
• Michelle Lamorte

• General Practice Dentistry in Columbus, GA
• Providers in Columbus, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.