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General NPI Number Information
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NPI Number | 1710098439
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Entity Type | Organization
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Legal Business Name | BALCONES FAMILY DENTAL
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 9000 ANDERSON MILL RD
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City | AUSTIN
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State | TX
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Zip | 78729
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Country | US
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Telephone | 512-331-9088
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Fax | 512-918-9017
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Provider Business Mailing Address
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Address Line | 9000 ANDERSON MILL RD
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City | AUSTIN
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State | TX
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Zip | 78729
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Country | US
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Telephone | 512-331-9088
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Fax | 512-918-9017
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL MARVIN LOUNSBERRY JR.
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Credential | DDS PA
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Telephone | 512-331-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14090
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License Number State | TX
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