Provider Demographics
NPI:1609289644
Name:HILL COUNTRY PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:HILL COUNTRY PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-809-4162
Mailing Address - Street 1:12225 FM 2244 RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5310
Mailing Address - Country:US
Mailing Address - Phone:512-263-7455
Mailing Address - Fax:512-263-7460
Practice Address - Street 1:12225 FM 2244 RD STE 100
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-5310
Practice Address - Country:US
Practice Address - Phone:512-263-7455
Practice Address - Fax:512-263-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty