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General NPI Number Information
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NPI Number | 1649280421
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Entity Type | Individual
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Provider Name | ANTONIA PEREGONOV KOOB D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2500 W PARMER LN SUITE 140
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City | AUSTIN
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State | TX
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Zip | 78727-4233
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Country | US
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Telephone | 512-837-6100
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Fax | 512-733-5600
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Provider Business Mailing Address
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Address Line | 2508 MERION CV
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City | ROUND ROCK
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State | TX
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Zip | 78664-6231
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Country | US
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Telephone | 512-238-9742
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Fax | 512-733-5600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20366
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License Number State | TX
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