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General NPI Number Information
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NPI Number | 1114571031
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Entity Type | Organization
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Legal Business Name | HUDSON BEND DENTAL LLC
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 1605 RR 620 N STE 300
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City | LAKEWAY
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State | TX
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Zip | 78734-2371
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Country | US
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Telephone | 512-587-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 3906 ECK LN
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City | AUSTIN
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State | TX
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Zip | 78734-1615
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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 | PRES
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Name | DR. GREGORY WATSON
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Credential | DDS
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Telephone | 512-587-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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