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General NPI Number Information
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NPI Number | 1659849180
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Entity Type | Organization
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Legal Business Name | TOTAL ORAL REHABILITATION AND COSMETIC DENTAL
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 2690 E. HWY 290 SUITE 400
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78260
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Country | US
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Telephone | 512-607-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2690 E. HWY 290, SUITE 400
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TRISTAN CHEUNG
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Credential | DMD
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Telephone | 512-607-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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