Provider Demographics
NPI:1407001233
Name:HILL COUNTRY PEDIATRIC DENTISTRY, PA
Entity Type:Organization
Organization Name:HILL COUNTRY PEDIATRIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-693-7044
Mailing Address - Street 1:608 GATEWAY CENTRAL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6354
Mailing Address - Country:US
Mailing Address - Phone:830-693-7044
Mailing Address - Fax:830-693-2069
Practice Address - Street 1:12225 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:BEE CAVES
Practice Address - State:TX
Practice Address - Zip Code:78738
Practice Address - Country:US
Practice Address - Phone:512-263-7455
Practice Address - Fax:512-263-7460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILL COUNTRY PEDIATRIC DENTISTRY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-20
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200811223P0221X
TX198181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty