Lake Leon Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LAKE LEON DENTAL PLLC

Practice address

1420 E Main St
Eastland, TX 76448-3023

Phone

(254) 629-7110

Fax

(254) 629-7110

NPI assigned

Jun 10, 2026

Last updated

Sep 24, 2026By 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

Raghav Puri, BDS, MS

Title

Owner/Dentist

Phone

(254) 629-7110

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1781049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790208000000",
    "number": "1710811237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 E MAIN ST",
            "city": "EASTLAND",
            "state": "TX",
            "postal_code": "764483023",
            "telephone_number": "254-629-7110",
            "fax_number": "254-629-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 E MAIN ST",
            "city": "EASTLAND",
            "state": "TX",
            "postal_code": "764483023",
            "telephone_number": "254-629-7110",
            "fax_number": "254-629-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE LEON DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-10",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A",
        "authorized_official_last_name": "PURI",
        "authorized_official_first_name": "RAGHAV",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "254-629-7110",
        "authorized_official_credential": "BDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Eastland, TX
• Providers in Eastland, TX by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; 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.