| Lakeline Rising Stars Pediatric Dentistry | |
|
14005 N. Hwy 183 #800 Austin TX 78717 | |
| (512) 266-7200 | |
| (512) 583-0675 |
| Full Name | Lakeline Rising Stars Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 14005 N. Hwy 183, Austin, Texas |
| Authorized Official Name and Position | Jeffrey B Gregerson (OWNER) |
| Authorized Official Contact | 5122667200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeline Rising Stars Pediatric Dentistry 14005 N. Hwy 183 # 800 Austin TX 78717 Ph: (512) 266-7200 | Lakeline Rising Stars Pediatric Dentistry 14005 N. Hwy 183 #800 Austin TX 78717 Ph: (512) 266-7200 |
| NPI Number | 1447595855 |
|---|---|
| Provider Enumeration Date | 12/11/2012 |
| Last Update Date | 03/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447595855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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