SD PARK LAKE PLLC

NPI: 1164111241 · WACO, TX 76708 · General Practice Dentistry · NPI assigned 05/03/2023

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official PHAM, LYNHTHY controls 20+ related entities in our dataset. Read more

$2K

Total Medicaid Paid

205

Total Claims

159

Beneficiaries

Codes Billed

2024-01

First Month

2024-07

Last Month

Provider Details

Authorized Official	PHAM, LYNHTHY (OWNER)
NPI Enumeration Date	05/03/2023

Other providers sharing the same authorized official: PHAM, LYNHTHY

Provider	City	State	Total Paid
SD GREENVILLE LLC	GREENVILLE	TX	$719K
SD CORPUS CHRISTI PLLC	CORPUS CHRISTI	TX	$557K
SD- ROOSEVELT PC	SAN ANTONIO	TX	$314K
SD TEXARKANA	TEXARKANA	TX	$280K
SD- 4315FREDERICK PC	SAN ANTONIO	TX	$218K
SMILEY DENTAL SINGLETON PLLC	DALLAS	TX	$215K
SD- POTRANCO, PC	SAN ANTONIO	TX	$178K
SMILEY DENTAL - UNIVERSITY	DENTON	TX	$114K
SMILEY DENTAL MCCART PLLC	FORT WORTH	TX	$55K
SMILEY DENTAL KEMP PLLC	WICHITA FALLS	TX	$47K
SD MEADOWBROOK PLLC	FORT WORTH	TX	$26K
SD-BRAUN, PC	SAN ANTONIO	TX	$22K
SD-933SCHERTZ PC	SCHERTZ	TX	$22K
SD-HWY 78 PC	SAN ANTONIO	TX	$20K
SD-DEZAVALA PC	SAN ANTONIO	TX	$15K
SMILEY DENTAL LAMAR PLLC	AUSTIN	TX	$12K
SD SAGINAW PLLC	SAGINAW	TX	$8K
SD PARK ROW PLLC	ARLINGTON	TX	$6K
SD HALTOM CITY PLLC	HALTOM CITY	TX	$4K
SD VALLEY MILLS PLLC	WACO	TX	$3K

Year	Claims	Total Paid
2024	205	$2K

Code	Description	Claims	Beneficiaries	Total Paid
D0330	Panoramic radiographic image	28	25	$745.07
D0150	Comprehensive oral evaluation - new or established patient	17	16	$536.84
D1208	Topical application of fluoride, excluding varnish	25	24	$333.69
D0230	Intraoral - periapical each additional radiographic image	65	27	$242.09
D0274	Bitewings - four radiographic images	13	13	$222.77
D0220	Intraoral - periapical first radiographic image	29	29	$157.26
D0603		28	25	$0.01