Healthcare Provider Details

I. General information

NPI: 1346470333
Provider Name (Legal Business Name): BOOKMYER AND BOOKMYER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ROUND ROCK AVE
ROUND ROCK TX
78681-4010
US

IV. Provider business mailing address

2100 ROUND ROCK AVE
ROUND ROCK TX
78681-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3855
  • Fax: 512-733-5022
Mailing address:
  • Phone: 512-244-3855
  • Fax: 512-733-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18295
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18581
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN BRADLEY BOOKMYER
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 512-244-3855