=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487161238
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUBREY PEDIATRIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2018
-----------------------------------------------------
Last Update Date | 01/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26615 US HIGHWAY 380 E STE 130
-----------------------------------------------------
City | AUBREY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76227-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-365-9490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8520 SILVERLEAF CIR
-----------------------------------------------------
City | LANTANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76226-5594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-261-5254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PRESIDENT
-----------------------------------------------------
Name | DR. NATHAN ROMNEY
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 940-365-9490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------