| Lone Star Pediatric Dental | |
|
8716 Research Blvd # 125 Austin TX 78758-6420 | |
| (512) 454-4646 | |
| (512) 419-0561 |
| Full Name | Lone Star Pediatric Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 8716 Research Blvd # 125, Austin, Texas |
| Authorized Official Name and Position | Marty Montgomery (PRESIDENT) |
| Authorized Official Contact | 5125746923 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lone Star Pediatric Dental 8716 Research Blvd # 125 Austin TX 78758-6420 Ph: (512) 454-4646 | Lone Star Pediatric Dental 8716 Research Blvd # 125 Austin TX 78758-6420 Ph: (512) 454-4646 |
| NPI Number | 1215280557 |
|---|---|
| Provider Enumeration Date | 10/24/2012 |
| Last Update Date | 10/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215280557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 24217 (Texas) | Primary |
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