|
| |
|
1011 W 5th St Ste 120 Austin TX 78703-5363 | |
| (512) 617-0101 | |
| (512) 617-0102 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1011 W 5th St Ste 120, Austin, Texas |
| Authorized Official Name and Position | Clint Finch Herzog (CEO/PRESIDENT) |
| Authorized Official Contact | 2148717100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1011 W 5th St Ste 120 Austin TX 78703-5363 Ph: (512) 617-0101 | 1011 W 5th St Ste 120 Austin TX 78703-5363 Ph: (512) 617-0101 |
| NPI Number | 1376838961 |
|---|---|
| Provider Enumeration Date | 06/13/2011 |
| Last Update Date | 06/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376838961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 20239 (Texas) | Primary |
| 122300000X | Dentist | 25630 (Texas) | 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 | |