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General NPI Number Information
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NPI Number | 1881332450
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Entity Type | Organization
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Legal Business Name | HERO WAY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 12621 HERO WAY W SUITE A1
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City | LEANDER
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State | TX
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Zip | 78641
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Country | US
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Telephone | 503-551-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 11909 BROOKWOOD RD
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City | AUSTIN
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State | TX
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Zip | 78750-2744
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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 | CEO
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Name | YU LI
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Credential | DMD
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Telephone | 503-551-5700
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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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