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15004 Avery Ranch Blvd # 100 Austin TX 78717-4600 | |
| (512) 246-7645 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15004 Avery Ranch Blvd # 100, Austin, Texas |
| Authorized Official Name and Position | Amanda Lightfoot (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Contact | 2147020708 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15004 Avery Ranch Blvd # 100 Austin TX 78717-4600 Ph: (512) 246-7645 | 15004 Avery Ranch Blvd # 100 Austin TX 78717-4600 Ph: (512) 246-7645 |
| NPI Number | 1417675372 |
|---|---|
| Provider Enumeration Date | 08/17/2022 |
| Last Update Date | 10/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417675372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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 | |