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General NPI Number Information
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NPI Number | 1932813219
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Entity Type | Organization
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Legal Business Name | LIVE OAK PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 8056 SHIN OAK DR STE 200
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City | LIVE OAK
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State | TX
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Zip | 78233-2957
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Country | US
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Telephone | 210-441-3360
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Fax | 210-441-3387
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Provider Business Mailing Address
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Address Line | 8056 SHIN OAK DR STE 200
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City | LIVE OAK
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State | TX
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Zip | 78233-2957
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Country | US
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Telephone | 210-441-3360
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Fax | 210-441-3387
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Authorized Official
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Title or Position | OWNER
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Name | JERAME HAFEN
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Credential | DDS
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Telephone | 210-845-8831
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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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