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General NPI Number Information
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NPI Number | 1558832972
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Entity Type | Organization
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Legal Business Name | BELTERRA KIDS TEETH
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 12/11/2018
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Provider Practice Location Address
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Address Line | 165 HARGRAVES DR STE M100
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City | AUSTIN
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State | TX
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Zip | 78737-4810
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Country | US
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Telephone | 512-229-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 165 HARGRAVES DR STE M100
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City | AUSTIN
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State | TX
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Zip | 78737-4810
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Country | US
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Telephone | 512-229-0604
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. MELANIE BETH BABOT
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Credential | DDS
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Telephone | 512-229-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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