Lake Travis Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

22434 Issued in TX

Legal business name

LAKE TRAVIS PEDIATRIC DENTISTRY

Practice address

1008 RR 620 S
Suite # 201
Lakeway, TX 78734-5631

Phone

(512) 263-1000

NPI assigned

Apr 6, 2009

Organization subpart

No

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

Authorized official

Name

Reza Arzegar, D.D.S.

Title

Vice President

Phone

(512) 263-1000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1508008590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 RR 620 S",
            "address_2": "SUITE # 201",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345631",
            "telephone_number": "512-263-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 RR 620 S",
            "address_2": "SUITE # 201",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345631",
            "telephone_number": "512-263-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TRAVIS PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2009-04-06",
        "status": "A",
        "authorized_official_last_name": "ARZEGAR",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "512-263-1000",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "22434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lakeway Dental Solutions. LLC
• Lakeway Dermatology and Skin Cancer (Mary Ana Cunningham)
• Lakeway Era Acquistion Partners LLC (Vik Complete Care Lakeway)

• Pediatric Dentistry in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.