Provider Demographics
NPI:1235553900
Name:CENTRAL TEXAS FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:CENTRAL TEXAS FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-914-0000
Mailing Address - Street 1:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-1606
Mailing Address - Country:US
Mailing Address - Phone:325-388-6021
Mailing Address - Fax:325-388-9991
Practice Address - Street 1:1117 RANCH ROAD 1431
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-4055
Practice Address - Country:US
Practice Address - Phone:325-388-6021
Practice Address - Fax:325-388-9991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGSLAND PROFESSIONAL PROPERTY L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780933374OtherNPPES