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General NPI Number Information
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NPI Number | 1922355437
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Entity Type | Organization
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Legal Business Name | LEANDER PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 903 OLD BAGDAD RD
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City | LEANDER
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State | TX
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Zip | 78641-1994
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Country | US
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Telephone | 617-869-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 903 OLD BAGDAD RD
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City | LEANDER
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State | TX
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Zip | 78641-1994
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Country | US
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Telephone | 617-869-5264
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT FURROW
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Credential |
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Telephone | 617-869-5264
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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 | 25126
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License Number State | TX
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