NPIMap

Organization Active NPI

Lakeshore Dental PLLC

  • Dentist
  • Rockwall, TX
National Provider Identifier
1457787970
Registry record updated Aug 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
22206 Issued in TX
Legal business name
LAKESHORE DENTAL PLLC
Practice address
3045 N Goliad St
Suite 105
Rockwall, TX 75087-7092
Phone
(972) 722-9100
Fax
(972) 722-9103
NPI assigned
Sep 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2015

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

Authorized official

Name
Dr. Jaime Villarreal, D.D.S
Title
Dr./Owner
Phone
(972) 722-9100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 22206 TX Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 21771 TX

Addresses

Primary practice location

3045 N Goliad St
Suite 105
Rockwall, TX 75087-7092

Mailing address

3045 N Goliad St
Suite 105
Rockwall, TX 75087-7092
Phone (972) 722-9100

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440720000000",
    "number": "1457787970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3045 N GOLIAD ST",
            "address_2": "SUITE 105",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750877092",
            "telephone_number": "972-722-9100",
            "fax_number": "972-722-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 N GOLIAD ST",
            "address_2": "SUITE 105",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750877092",
            "telephone_number": "972-722-9100",
            "fax_number": "972-722-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2015-08-28",
        "status": "A",
        "authorized_official_last_name": "VILLARREAL",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "DR./OWNER",
        "authorized_official_telephone_number": "972-722-9100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22206",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "21771",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; 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.