Healthcare Provider Details

I. General information

NPI: 1275764383
Provider Name (Legal Business Name): TRG DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S I H 35 SUITE 1-D
AUSTIN TX
78744-4824
US

IV. Provider business mailing address

6801 S I H 35 SUITE 1-D
AUSTIN TX
78744-4824
US

V. Phone/Fax

Practice location:
  • Phone: 512-507-3771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21522
License Number StateTX

VIII. Authorized Official

Name: DR. TODD R. GARCIA
Title or Position: OWNER
Credential: DDS
Phone: 512-507-3771