Provider Demographics
NPI:1639610421
Name:DRIPPING SPRINGS PEDIATRIC DENTAL, PLLC
Entity Type:Organization
Organization Name:DRIPPING SPRINGS PEDIATRIC DENTAL, PLLC
Other - Org Name:LONE STAR PEDIATRIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-676-4444
Mailing Address - Street 1:505 E HUNTLAND DR STE 340
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3745
Mailing Address - Country:US
Mailing Address - Phone:512-206-2975
Mailing Address - Fax:
Practice Address - Street 1:2440 E HIGHWAY 290. BUILDING C, SUITE B
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-676-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty