Healthcare Provider Details

I. General information

NPI: 1508270166
Provider Name (Legal Business Name): TWINSCA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E WHITESTONE BLVD STE D
CEDAR PARK TX
78613-9096
US

IV. Provider business mailing address

6280 MCNEIL DR APT 513
AUSTIN TX
78729-6982
US

V. Phone/Fax

Practice location:
  • Phone: 512-670-8880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number27233
License Number StateTX

VIII. Authorized Official

Name: DR. SAMIR MOMIN
Title or Position: PRESIDENT
Credential: DDS
Phone: 512-740-1435