Provider Demographics
NPI:1467832014
Name:MARBLE FALLS PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:MARBLE FALLS PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-419-3235
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:830-428-2255
Mailing Address - Fax:
Practice Address - Street 1:608 GATEWAY CENTRAL
Practice Address - Street 2:SUITE 201
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6354
Practice Address - Country:US
Practice Address - Phone:830-428-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty