Provider Demographics
NPI:1376164251
Name:TX DDS ALLIANCE - MARBELLA, LLC
Entity Type:Organization
Organization Name:TX DDS ALLIANCE - MARBELLA, LLC
Other - Org Name:CEDAR PARK DENTAL & BRACES
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:512-410-1436
Mailing Address - Street 1:115 S LAKELINE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2762
Mailing Address - Country:US
Mailing Address - Phone:512-640-3360
Mailing Address - Fax:
Practice Address - Street 1:115 S LAKELINE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2762
Practice Address - Country:US
Practice Address - Phone:512-640-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TX DDS ALLIANCE - MARBELLA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-01
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental