MEDICARE: TWIN FOUNTAINS 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	122300000X	Dentist

General Provider Information

NPI Number	:	1477332351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN FOUNTAINS DENTAL, PLLC

Provider Business Mailing Address
First Line	:	1400 GUADALUPE ST STE A
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-5316
Country	:	US
Telephone Number	:	956-242-4245
Fax Number	:	956-489-5064

Provider Business Practice Location Address
First Line	:	9717 N LAMAR BLVD STE B3
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-4143
Country	:	US
Telephone Number	:	956-242-4245
Fax Number	:	956-489-5064

Authorized Official
Title or Position	:	CO-OWNER
Name	:	PAUL A LABBE
Credential	:	DDS
Telephone Number	:	956-242-4245

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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