Provider Demographics
NPI:1497026876
Name:PFLUGERVILLE DENTAL
Entity Type:Organization
Organization Name:PFLUGERVILLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-670-9991
Mailing Address - Street 1:15803 WINDERMERE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2402
Mailing Address - Country:US
Mailing Address - Phone:512-670-9991
Mailing Address - Fax:512-670-3000
Practice Address - Street 1:15803 WINDERMERE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2402
Practice Address - Country:US
Practice Address - Phone:512-670-9991
Practice Address - Fax:512-670-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty