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General NPI Number Information
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NPI Number | 1477049690
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Entity Type | Organization
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Legal Business Name | PARMER LANE ORTHODONTICS PC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 2121 W PARMER LN STE 111
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City | AUSTIN
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State | TX
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Zip | 78727-4360
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Country | US
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Telephone | 512-793-9325
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 W PARMER LN STE 111
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City | AUSTIN
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State | TX
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Zip | 78727-4360
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Country | US
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Telephone | 512-793-9325
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIP DESAI
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Credential | DDS
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Telephone | 517-793-9325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30390
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License Number State | TX
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