Provider Demographics
NPI:1629638085
Name:GLLLV, PLLC
Entity Type:Organization
Organization Name:GLLLV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:UECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-345-3166
Mailing Address - Street 1:7030 VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3024
Mailing Address - Country:US
Mailing Address - Phone:512-345-3166
Mailing Address - Fax:
Practice Address - Street 1:7030 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3024
Practice Address - Country:US
Practice Address - Phone:512-345-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty