Healthcare Provider Details

I. General information

NPI: 1972198794
Provider Name (Legal Business Name): SIO OF TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/04/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2853 N MAIN ST
BELTON TX
76513-1141
US

IV. Provider business mailing address

505 E HUNTLAND DR
AUSTIN TX
78752-3717
US

V. Phone/Fax

Practice location:
  • Phone: 254-233-2037
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MONICA PERKINS
Title or Position: ONBOARDING SPECIALIST
Credential:
Phone: 678-244-4844