Provider Demographics
NPI:1871923284
Name:LAGO VISTA FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:LAGO VISTA FAMILY DENTISTRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-817-4940
Mailing Address - Street 1:1907 S. US-183
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-817-4940
Mailing Address - Fax:512-817-4955
Practice Address - Street 1:8008 BRONCO LANE
Practice Address - Street 2:SUITE B
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645
Practice Address - Country:US
Practice Address - Phone:512-277-3311
Practice Address - Fax:512-727-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty