| Great Grins Dental Pllc | |
|
5114 Balcones Woods Dr Ste 308 Austin TX 78759-5212 | |
| (512) 346-1900 | |
| Not Available |
| Full Name | Great Grins Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5114 Balcones Woods Dr Ste 308, Austin, Texas |
| Authorized Official Name and Position | Brent Eugene Fossum (DENTIST) |
| Authorized Official Contact | 7139722044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Grins Dental Pllc 5672 Rain Creek Pkwy Austin TX 78759-6201 Ph: (713) 972-2044 | Great Grins Dental Pllc 5114 Balcones Woods Dr Ste 308 Austin TX 78759-5212 Ph: (512) 346-1900 |
| NPI Number | 1144839390 |
|---|---|
| Provider Enumeration Date | 07/23/2020 |
| Last Update Date | 07/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144839390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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