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2410 E Riverside Dr Ste. H12 Austin TX 78741-3083 | |
| (512) 442-1224 | |
| (512) 442-8588 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2410 E Riverside Dr, Austin, Texas |
| Authorized Official Name and Position | F. Ricardo Moreno (OWNER PRESIDENT) |
| Authorized Official Contact | 5124421224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2410 E Riverside Dr Ste. H12 Austin TX 78741-3083 Ph: (512) 442-1224 | 2410 E Riverside Dr Ste. H12 Austin TX 78741-3083 Ph: (512) 442-1224 |
| NPI Number | 1336368554 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 10/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336368554 | NPI | - | NPPES |
| 090753702 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 18322 (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 | |