Healthcare Provider Details

I. General information

NPI: 1801578919
Provider Name (Legal Business Name): ACRE WOOD DENTAL - ROUND ROCK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15930 S GREAT OAKS DR STE A100
ROUND ROCK TX
78681-5686
US

IV. Provider business mailing address

15930 S GREAT OAKS DR STE A100
ROUND ROCK TX
78681-5686
US

V. Phone/Fax

Practice location:
  • Phone: 512-910-3456
  • Fax: 512-910-3353
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN JOHNSON
Title or Position: OWNER
Credential: DDS
Phone: 254-799-5461