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General NPI Number Information
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NPI Number | 1295286623
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Entity Type | Organization
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Legal Business Name | HUTTO MODERN DENTISTRY,PC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 5002 GATTIS SCHOOL RD SUITE 200
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City | HUTTO
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State | TX
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Zip | 78634
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Country | US
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Telephone | 512-501-4148
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Fax | 512-920-6421
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 512-501-4148
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Fax | 512-920-6421
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. BENJAMIN J POEST
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Credential | DDS
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Telephone | 512-501-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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