1831528512 NPI number — MARKET STREET FAMILY DENTAL,PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831528512 NPI number — MARKET STREET FAMILY DENTAL,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARKET STREET FAMILY DENTAL,PLLC
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:
1831528512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 LBJ FWY
Provider Second Line Business Mailing Address:
STE 944
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-982-8490
Provider Business Mailing Address Fax Number:
972-982-8492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 E WHITESTONE BLVD
Provider Second Line Business Practice Location Address:
STE. 225
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-7273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-337-0993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CAPARAS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-982-8492

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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)





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