Provider Demographics
NPI:1275764383
Name:TRG DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:TRG DENTAL ASSOCIATES
Other - Org Name:SUPERSMILES DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-507-3771
Mailing Address - Street 1:6801 S I H 35
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 S I H 35
Practice Address - Street 2:SUITE 1-D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-507-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty