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General NPI Number Information
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NPI Number | 1932451887
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Entity Type | Organization
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Legal Business Name | HUTTO PREMIER DENTISTRY PA
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 60 CHRIS KELLEY BLVD
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City | HUTTO
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State | TX
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Zip | 78634-5298
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Country | US
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Telephone | 512-846-2646
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Fax | 512-846-1169
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Provider Business Mailing Address
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Address Line | 123 ED SCHMIDT BLVD 100
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City | HUTTO
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State | TX
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Zip | 78634-5585
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Country | US
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Telephone | 512-846-2646
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Fax | 512-846-1258
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOHN FOWLER MCENTIRE
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Credential | FGAD
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Telephone | 512-846-2646
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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 | 22799
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License Number State | TX
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