Healthcare Provider Details

I. General information

NPI: 1609299544
Provider Name (Legal Business Name): LEAD HOLDINGS LTD., LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 OLD FREDERICKSBURG RD SUITE D-102
AUSTIN TX
78749-1209
US

IV. Provider business mailing address

5901 OLD FREDERICKSBURG RD SUITE D-102
AUSTIN TX
78749-1209
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-9900
  • Fax: 512-892-9903
Mailing address:
  • Phone: 512-892-9900
  • Fax: 512-892-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DARIAN KARR
Title or Position: OWNER
Credential: DDS, MSD
Phone: 512-892-9900