Healthcare Provider Details

I. General information

NPI: 1639181373
Provider Name (Legal Business Name): ROBERT RAMIREZ JR. DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11671 JOLLYVILLE RD SUITE 101
AUSTIN TX
78759-4139
US

IV. Provider business mailing address

11671 JOLLYVILLE RD SUITE 101
AUSTIN TX
78759-4139
US

V. Phone/Fax

Practice location:
  • Phone: 512-335-8600
  • Fax: 512-996-8118
Mailing address:
  • Phone: 512-335-8600
  • Fax: 512-996-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: