=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235553900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL TEXAS FAMILY DENTISTRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2014
-----------------------------------------------------
Last Update Date | 02/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1117 RANCH ROAD 1431
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78639-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-388-6021
-----------------------------------------------------
Fax | 325-388-9991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1606
-----------------------------------------------------
City | KINGSLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78639-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-388-6021
-----------------------------------------------------
Fax | 325-388-9991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT EDWIN SAWYER
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 832-914-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 28332
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------