| Rising Stars Pd Lakeline, Pllc | |
|
14005 N Hwy 183 Ste 800 Austin TX 78717-5960 | |
| (512) 266-7200 | |
| Not Available |
| Full Name | Rising Stars Pd Lakeline, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 14005 N Hwy 183 Ste 800, Austin, Texas |
| Authorized Official Name and Position | Serenthes Fields (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4076843738 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Stars Pd Lakeline, Pllc 14005 N Hwy 183 Ste 800 Austin TX 78717-5960 Ph: (512) 266-7200 | Rising Stars Pd Lakeline, Pllc 14005 N Hwy 183 Ste 800 Austin TX 78717-5960 Ph: (512) 266-7200 |
| NPI Number | 1912780461 |
|---|---|
| Provider Enumeration Date | 08/17/2023 |
| Last Update Date | 08/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912780461 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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