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2500 W William Cannon Dr Austin TX 78745-5257 | |
(512) 662-1455 | |
Not Available |
Full Name | |
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Speciality | Dentist - Pediatric Dentistry |
Location | 2500 W William Cannon Dr, Austin, Texas |
Authorized Official Name and Position | Sofia Luque (OWNER) |
Authorized Official Contact | 5129653355 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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11109 Comiso Pala Path Austin TX 78726-2409 Ph: (512) 965-3355 | 2500 W William Cannon Dr Austin TX 78745-5257 Ph: (512) 662-1455 |
NPI Number | 1679841613 |
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Provider Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |
Identifier | Type | State | Issuer |
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1679841613 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223P0221X | Dentist - Pediatric Dentistry | 24159 (Texas) | 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 | |