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General NPI Number Information
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NPI Number | 1871370262
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Entity Type | Organization
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Legal Business Name | WHITE BLOSSOM DENTAL PLLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 3200 FM 1460 BLDG 3, SUITE 305
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City | GEORGETOWN
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State | TX
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Zip | 78626
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Country | US
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Telephone | 737-253-9535
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Fax |
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Provider Business Mailing Address
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Address Line | 120 TEXON DR
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City | LIBERTY HILL
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State | TX
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Zip | 78642-2151
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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 | PEDIATRIC DENTIST
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Name | DR. MICHELLE ZIN
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Credential |
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Telephone | 737-253-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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