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General NPI Number Information
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NPI Number | 1053899435
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Entity Type | Organization
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Legal Business Name | WEST BANDERA DENTAL, PLLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 430 W BANDERA RD
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City | BOERNE
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State | TX
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Zip | 78006-2500
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Country | US
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Telephone | 830-428-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 E MCKINNEY ST STE 100
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City | DENTON
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State | TX
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Zip | 76209-7557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DDS
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Name | EVERETT CHAD EVANS
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Credential | DDS
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Telephone | 830-428-3698
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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 | 23695
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License Number State | TX
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