Provider Demographics
NPI:1578223855
Name:DENTAL REPUBLIC- ROUND ROCK, LLC
Entity Type:Organization
Organization Name:DENTAL REPUBLIC- ROUND ROCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-747-1400
Mailing Address - Street 1:3211 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5944
Mailing Address - Country:US
Mailing Address - Phone:972-204-5231
Mailing Address - Fax:
Practice Address - Street 1:2601 S IH 35
Practice Address - Street 2:BLDG A STE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:972-747-1400
Practice Address - Fax:214-242-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty