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General NPI Number Information
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NPI Number | 1972487593
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Entity Type | Organization
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Legal Business Name | MOUNT ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 4873 WILLIAMS DR STE 105
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City | GEORGETOWN
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State | TX
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Zip | 78633-2428
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Country | US
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Telephone | 512-508-6104
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Fax |
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Provider Business Mailing Address
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Address Line | 310 RUNNING M ST
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City | GEORGETOWN
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State | TX
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Zip | 78633-2908
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Country | US
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Telephone | 512-508-6104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY TANNER MOUNT
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Credential | DDS
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Telephone | 512-508-6104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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