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General NPI Number Information
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NPI Number | 1265660518
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Entity Type | Organization
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Legal Business Name | BAYLOR MEDICAL & DENTAL
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 8741 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-5423
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Country | US
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Telephone | 512-832-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 8741 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-5423
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Country | US
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Telephone | 512-832-6395
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RHONDA PHAM
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Credential |
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Telephone | 512-832-6395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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