| Anderson Lane Dental | |
|
1802 W Anderson Ln Austin TX 78757-1338 | |
| (512) 459-4347 | |
| (512) 459-4348 |
| Full Name | Anderson Lane Dental |
|---|---|
| Speciality | Dentist |
| Location | 1802 W Anderson Ln, Austin, Texas |
| Authorized Official Name and Position | Gerald Bernard Pevow (OWNER) |
| Authorized Official Contact | 5124594347 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Anderson Lane Dental 1802 W Anderson Ln Austin TX 78757-1338 Ph: (512) 459-4347 | Anderson Lane Dental 1802 W Anderson Ln Austin TX 78757-1338 Ph: (512) 459-4347 |
| NPI Number | 1457772816 |
|---|---|
| Provider Enumeration Date | 01/02/2014 |
| Last Update Date | 01/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457772816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 28268 (Texas) | Primary |
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