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General NPI Number Information
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NPI Number | 1033309091
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Entity Type | Organization
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Legal Business Name | SIGNATURE SMILES, P.A.,
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 5320 BURNET ROAD STE#108
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City | AUSTIN
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State | TX
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Zip | 78756
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Country | US
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Telephone | 512-832-6225
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Fax | 512-832-8454
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Provider Business Mailing Address
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Address Line | 5320 BURNET ROAD STE#108
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City | AUSTIN
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State | TX
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Zip | 78756
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Country | US
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Telephone | 512-832-6225
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Fax | 512-832-8454
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Authorized Official
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Title or Position | OWNER
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Name | RONALD JOHN CALDWELL JR.
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Credential | DDS
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Telephone | 512-832-6225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22132
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License Number State | TX
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