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General NPI Number Information
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NPI Number | 1851676027
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Entity Type | Organization
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Legal Business Name | TOTAL SMILE MANAGEMENT PC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 11149 RESEARCH BLVD SUITE 270
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City | AUSTIN
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State | TX
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Zip | 78759-5279
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Country | US
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Telephone | 512-346-1221
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Fax | 512-502-9689
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Provider Business Mailing Address
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Address Line | 11149 RESEARCH BLVD SUITE 270
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City | AUSTIN
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State | TX
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Zip | 78759-5279
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Country | US
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Telephone | 512-346-1221
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Fax | 512-502-9689
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ALBERT MILNER TATE JR.
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Credential | D.D.S., M.S.D.
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Telephone | 512-346-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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