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General NPI Number Information
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NPI Number | 1841709334
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Entity Type | Organization
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Legal Business Name | SOMERICA DENTAL, PC
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 4613 BEE CAVES RD STE 101
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5206
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Country | US
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Telephone | 512-327-1222
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Fax | 512-327-1232
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Provider Business Mailing Address
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Address Line | 4613 BEE CAVES RD STE 101
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5206
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Country | US
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Telephone | 512-327-1222
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Fax | 512-327-1232
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | JOSHUA OWEN DAAB
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Credential |
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Telephone | 512-259-1250
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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 | 30545
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License Number State | TX
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