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General NPI Number Information
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NPI Number | 1184030538
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Entity Type | Organization
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Legal Business Name | CENTER OF COSMETICS AND GENERAL DENTISTRY
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 1213 RR 620 S SUITE 205
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City | LAKEWAY
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State | TX
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Zip | 78734-6340
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Country | US
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Telephone | 512-263-8337
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Fax | 512-402-9558
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Provider Business Mailing Address
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Address Line | 1213 RR 620 S SUITE 205
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City | LAKEWAY
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State | TX
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Zip | 78734-6340
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Country | US
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Telephone | 512-263-8337
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Fax | 512-402-9558
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Authorized Official
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Title or Position | OWNER
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Name | TEJAS PATEL
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Credential | D.D.S.
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Telephone | 512-263-8337
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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 | 20997
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License Number State | TX
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