Healthcare Provider Details

I. General information

NPI: 1356070536
Provider Name (Legal Business Name): DOGLAS CECCHIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 ROUND ROCK AVE #100
ROUND ROCK TX
78681
US

IV. Provider business mailing address

1830 ROUND ROCK AVE #100
ROUND ROCK TX
78681
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-7373
  • Fax:
Mailing address:
  • Phone: 512-341-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40968
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number40968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: