=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033466073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY TOTAL DENTAL, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2012
-----------------------------------------------------
Last Update Date | 08/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 W 11TH ST #260
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78621-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-285-9685
-----------------------------------------------------
Fax | 512-352-1516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 910 W 11TH ST #260
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78621-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-285-9685
-----------------------------------------------------
Fax | 512-352-1516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. PAUL T DABNEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 512-285-9685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 14486
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------