Provider Demographics
NPI:1285840363
Name:FAMILY DENTISTRY & ORTHODONTIC CENTERS P.C.
Entity Type:Organization
Organization Name:FAMILY DENTISTRY & ORTHODONTIC CENTERS P.C.
Other - Org Name:OWNER HARRY F ROLAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:512-244-0113
Mailing Address - Street 1:1205 ROUND ROCK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4516
Mailing Address - Country:US
Mailing Address - Phone:512-244-0113
Mailing Address - Fax:
Practice Address - Street 1:1205 ROUND ROCK AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4516
Practice Address - Country:US
Practice Address - Phone:512-244-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135651223G0001X, 1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty