Provider Demographics
NPI:1538749270
Name:LAKEWAY DENTAL SOLUTIONS. LLC
Entity type:Organization
Organization Name:LAKEWAY DENTAL SOLUTIONS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-263-0064
Mailing Address - Street 1:1310 RANCH ROAD 620 SOUTH
Mailing Address - Street 2:STE. B6
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734
Mailing Address - Country:US
Mailing Address - Phone:512-263-0064
Mailing Address - Fax:512-263-2402
Practice Address - Street 1:1310 RANCH ROAD 620 SOUTH
Practice Address - Street 2:STE. B6
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-263-0064
Practice Address - Fax:512-263-2402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEWAY DENTAL SOLUTIONS. LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty