|
| |
|
3901 S Lamar Blvd Ste 480 Austin TX 78704-7990 | |
| (512) 448-3131 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3901 S Lamar Blvd Ste 480, Austin, Texas |
| Authorized Official Name and Position | Cassandra Petersen (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 2175408972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3901 S Lamar Blvd Ste 480 Austin TX 78704-7990 Ph: (512) 448-3131 | 3901 S Lamar Blvd Ste 480 Austin TX 78704-7990 Ph: (512) 448-3131 |
| NPI Number | 1639664246 |
|---|---|
| Provider Enumeration Date | 06/26/2018 |
| Last Update Date | 06/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639664246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Jared Poplin D.m.d., Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6850 Austin Center Blvd Ste 220, Austin, TX 78731 Phone: 785-691-6171 | |
Ac Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13616 N Highway 183, Austin, TX 78750 Phone: 512-682-5437 | |