MEDICARE: SONRISAS DENTAL CENTER - ROUND ROCK LLC- PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1053912329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONRISAS DENTAL CENTER - ROUND ROCK LLC- PC

Provider Business Mailing Address
First Line	:	505 W LOUIS HENNA BLVD STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1702
Country	:	US
Telephone Number	:	512-593-7970
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W LOUIS HENNA BLVD STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1702
Country	:	US
Telephone Number	:	512-593-7970
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAHYA FARNIA
Credential	:	DMD,MS
Telephone Number	:	737-781-9438

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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