Provider Demographics
NPI:1073631107
Name:PFLUGERVILLE ORTHODONTICS PA
Entity Type:Organization
Organization Name:PFLUGERVILLE ORTHODONTICS PA
Other - Org Name:SCOT A ODONNELL DDS MS AND BARBARA G ODONNELL DDS MS
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:512-989-8811
Mailing Address - Street 1:300 N HEATHERWILDE BLVD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:512-989-8811
Mailing Address - Fax:512-989-1525
Practice Address - Street 1:300 N HEATHERWILDE BLVD
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-989-8811
Practice Address - Fax:512-989-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty