| Fossil Dental | |
|
8142 Shin Oak Dr Ste 100 Live Oak TX 78233-2775 | |
| (210) 888-5832 | |
| Not Available |
| Full Name | Fossil Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8142 Shin Oak Dr Ste 100, Live Oak, Texas |
| Authorized Official Name and Position | Walter D Thames (OWNER/DENTIST) |
| Authorized Official Contact | 2108885832 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fossil Dental 8142 Shin Oak Dr Ste 100 Live Oak TX 78233-2775 Ph: (210) 888-5832 | Fossil Dental 8142 Shin Oak Dr Ste 100 Live Oak TX 78233-2775 Ph: (210) 888-5832 |
| NPI Number | 1164125456 |
|---|---|
| Provider Enumeration Date | 03/24/2023 |
| Last Update Date | 03/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164125456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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