Provider Demographics
NPI:1225678956
Name:TX DDS ALLIANCE - MARBELLA, LLC
Entity Type:Organization
Organization Name:TX DDS ALLIANCE - MARBELLA, LLC
Other - Org Name:MARBELLA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STIMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-774-5122
Mailing Address - Street 1:791 FM 1103 STE 119
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3673
Mailing Address - Country:US
Mailing Address - Phone:312-882-4484
Mailing Address - Fax:
Practice Address - Street 1:791 FM 1103 STE 119
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3673
Practice Address - Country:US
Practice Address - Phone:312-882-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TX DDS ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental