=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720827728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATCHED BEGINNINGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11671 JOLLYVILLE RD STE 204
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-814-7480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3106 DANCY ST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78722-2217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-516-9240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KACIE MARIE CULOTTA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 512-814-7480
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------