Healthcare Provider Details

I. General information

NPI: 1871992339
Provider Name (Legal Business Name): BRETT STRONG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 ROUND ROCK AVE SUITE 100
ROUND ROCK TX
78681-4021
US

IV. Provider business mailing address

1830 ROUND ROCK AVE SUITE 100
ROUND ROCK TX
78681-4021
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-7373
  • Fax: 512-341-8907
Mailing address:
  • Phone: 512-341-7373
  • Fax: 512-341-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number22545
License Number StateTX

VIII. Authorized Official

Name: DR. BRETT STRONG
Title or Position: DOCTOR
Credential: DDS
Phone: 512-608-3789