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General NPI Number Information
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NPI Number | 1336515436
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Entity Type | Organization
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Legal Business Name | PROSTHODONTICS OF TEXAS P.C.
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 5301 DAVIS LANE SUITE 101
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City | AUSTIN
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State | TX
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Zip | 78749
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Country | US
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Telephone | 512-960-4225
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Fax | 512-960-4800
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Provider Business Mailing Address
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Address Line | 5301 DAVIS LANE SUITE 101
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City | AUSTIN
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State | TX
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Zip | 78749
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Country | US
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Telephone | 512-960-4225
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Fax | 512-960-4800
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEWART WHITNEY PHARR
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Credential | DMD
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Telephone | 512-960-4225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 28864
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License Number State | TX
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