MEDICARE: HIGH POINT DENTISTRY SOCO, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588411821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH POINT DENTISTRY SOCO, PLLC

Provider Business Mailing Address
First Line	:	515 S CONGRESS AVE STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S CONGRESS AVE STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1775
Country	:	US
Telephone Number	:	512-448-9669
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VU KONG
Credential	:
Telephone Number	:	517-414-9468

Provider Enumeration Date	:	05/03/2024
Last Update Date	:	05/06/2024

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