MEDICARE: CEDAR HILLS DENTAL, 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	1223G0001X	General Practice Dentistry	19826	TX
2	1223G0001X	General Practice Dentistry	19414	TX

General Provider Information

NPI Number	:	1467749895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR HILLS DENTAL, PLLC

Provider Business Mailing Address
First Line	:	180 E WHITESTONE BLVD
Second Line	:	SUITE 162
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7433
Country	:	US
Telephone Number	:	512-259-6633
Fax Number	:	512-259-6590

Provider Business Practice Location Address
First Line	:	180 E WHITESTONE BLVD
Second Line	:	SUITE 162
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7433
Country	:	US
Telephone Number	:	512-259-6633
Fax Number	:	512-259-6590

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. SANDRA M SWANSON
Credential	:	D.D.S.
Telephone Number	:	512-259-6633

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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