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General NPI Number Information
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NPI Number | 1871989285
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Entity Type | Organization
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Legal Business Name | DAYLIGHT DENTAL, PLLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 6501 SOUTH CONGRESS AVE. SUITE 201
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City | AUSTIN
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State | TX
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Zip | 78745
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Country | US
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Telephone | 512-832-6840
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Fax | 512-782-8746
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Provider Business Mailing Address
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Address Line | PO BOX 82727
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City | AUSTIN
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State | TX
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Zip | 78708-2727
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Country | US
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Telephone | 512-832-6840
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Fax | 512-782-8746
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Authorized Official
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Title or Position | DENTIST
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Name | ALEEAHNA PHAN
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Credential | D.M.D.
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Telephone | 512-832-6840
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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 | 27164
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License Number State | TX
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