1982927661 NPI number — CENTRAL TEXAS PEDIATRIC DENTISTRY, PA

Table of content: (NPI 1982927661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982927661 NPI number — CENTRAL TEXAS PEDIATRIC DENTISTRY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS PEDIATRIC DENTISTRY, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982927661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 GATEWAY CENTRAL
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MARBLE FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78654-6354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-693-7044
Provider Business Mailing Address Fax Number:
830-693-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 BARBARA JORDAN BLVD
Provider Second Line Business Practice Location Address:
SUITE 1430
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78723-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-474-7575
Provider Business Practice Location Address Fax Number:
512-474-7583
Provider Enumeration Date:
03/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
830-693-7044

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  20081 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com