| Pecan Street Dental | |
|
708 Pecan St Bastrop TX 78602-3816 | |
| (512) 321-2188 | |
| Not Available |
| Full Name | Pecan Street Dental |
|---|---|
| Speciality | Dentist |
| Location | 708 Pecan St, Bastrop, Texas |
| Authorized Official Name and Position | Kevin Deutsch (OWNER) |
| Authorized Official Contact | 5123212188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pecan Street Dental 708 Pecan St Bastrop TX 78602-3816 Ph: () - | Pecan Street Dental 708 Pecan St Bastrop TX 78602-3816 Ph: (512) 321-2188 |
| NPI Number | 1558813030 |
|---|---|
| Provider Enumeration Date | 10/31/2016 |
| Last Update Date | 10/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558813030 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 25628 (Texas) | Primary |
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