Provider Demographics
NPI:1699044784
Name:CENTRAL TEXAS ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:CENTRAL TEXAS ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:254-399-9800
Mailing Address - Street 1:5180 W WACO DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7024
Mailing Address - Country:US
Mailing Address - Phone:254-399-9800
Mailing Address - Fax:254-399-9700
Practice Address - Street 1:5180 W WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7024
Practice Address - Country:US
Practice Address - Phone:254-399-9800
Practice Address - Fax:254-399-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175771223P0300X
TX1885591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty