MEDICARE: SECURE OF GEORGETOWN TX DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1356298277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE OF GEORGETOWN TX DDS PLLC

Provider Business Mailing Address
First Line	:	213 N BROADWAY ST
Second Line	:
City	:	CHECOTAH
State	:	OK
Zip	:	74426-2431
Country	:	US
Telephone Number	:	405-433-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	918-376-6600
Fax Number	:

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	ALEXANDER QUANTE
Credential	:	DDS
Telephone Number	:	918-376-6600

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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