Healthcare Provider Details

I. General information

NPI: 1881975035
Provider Name (Legal Business Name): HALF MOON DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 S INTERSTATE 35 SUITE 300
BUDA TX
78610-9703
US

IV. Provider business mailing address

2604 ROCK TERRACE DR
AUSTIN TX
78704-3842
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21522
License Number StateTX

VIII. Authorized Official

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