Provider Demographics
NPI:1477633113
Name:LONGHORN DENTAL
Entity Type:Organization
Organization Name:LONGHORN DENTAL
Other - Org Name:TSC DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-371-1222
Mailing Address - Street 1:7517 CAMERON ROAD
Mailing Address - Street 2:SUITE 107 LONGHORN DENTAL ASSOCIATES PC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:#345
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-836-3074
Practice Address - Fax:512-836-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty