MEDICARE: MDG ROUND ROCK 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

General Provider Information

NPI Number	:	1710664131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDG ROUND ROCK PLLC

Provider Business Mailing Address
First Line	:	9099 KATY FWY STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-1632
Country	:	US
Telephone Number	:	713-465-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 CHISHOLM TRAIL RD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5043
Country	:	US
Telephone Number	:	512-846-9051
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCE OFFICIER
Name	:	MS. THERESA NAVARRO
Credential	:
Telephone Number	:	713-677-9983

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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