Healthcare Provider Details

I. General information

NPI: 1093035966
Provider Name (Legal Business Name): ANDREW DAVID VERRETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N MOPAC EXPY
AUSTIN TX
78759-8900
US

IV. Provider business mailing address

7800 N MOPAC EXPY STE 310
AUSTIN TX
78759-8961
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-6097
  • Fax:
Mailing address:
  • Phone: 512-346-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0025482
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number25482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: