Provider Demographics
NPI:1518206382
Name:AABS DENTAL LLC
Entity Type:Organization
Organization Name:AABS DENTAL LLC
Other - Org Name:AABS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-680-3727
Mailing Address - Street 1:360 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1891
Mailing Address - Country:US
Mailing Address - Phone:254-680-3727
Mailing Address - Fax:254-680-8202
Practice Address - Street 1:360 W CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 203
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1891
Practice Address - Country:US
Practice Address - Phone:254-680-3727
Practice Address - Fax:254-680-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty