| |
2206 W Parmer Ln Austin TX 78727-4330 | |
(512) 835-1924 | |
(512) 835-2585 |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 2206 W Parmer Ln, Austin, Texas |
Authorized Official Name and Position | Destina Olivares (BUSINESS OPERATIONS MANAGER) |
Authorized Official Contact | 5128351924 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2206 W Parmer Ln Austin TX 78727-4330 Ph: (512) 835-1924 | 2206 W Parmer Ln Austin TX 78727-4330 Ph: (512) 835-1924 |
NPI Number | 1366588204 |
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Provider Enumeration Date | 01/29/2007 |
Last Update Date | 06/29/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366588204 | NPI | - | NPPES |
1427273382 | Other | TX | INDIVIDUAL |
1619600475 | Other | TX | INDIVIDUAL |
1528282407 | Other | TX | INDIVIDUAL |
1447748090 | Other | TX | INDIVIDUAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 13505 (Texas) | Secondary |
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
Jared Poplin D.m.d., Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6850 Austin Center Blvd Ste 220, Austin, TX 78731 Phone: 785-691-6171 | |
Ac Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13616 N Highway 183, Austin, TX 78750 Phone: 512-682-5437 | |