Provider Demographics
NPI:1558111096
Name:BREEZE DENTAL 38TH, PLLC
Entity Type:Organization
Organization Name:BREEZE DENTAL 38TH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-828-6471
Mailing Address - Street 1:3800 N. LAMAR BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-828-6471
Mailing Address - Fax:512-269-0080
Practice Address - Street 1:3800 N. LAMAR BLVD
Practice Address - Street 2:STE 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-828-6471
Practice Address - Fax:512-269-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BREEZE DENTAL 38TH, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty