=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578449641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGGIELAND ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2711 TEXAS AVENUE SOUTH SUITE 100
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-483-2264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10010 TUMBLING TRL
-----------------------------------------------------
City | MCGREGOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76657-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN MACHICEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-483-2264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------