Provider Demographics
NPI:1710098439
Name:BALCONES FAMILY DENTAL
Entity Type:Organization
Organization Name:BALCONES FAMILY DENTAL
Other - Org Name:PAUL M LOUNSBERRY JR DDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:LOUNSBERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:512-331-9088
Mailing Address - Street 1:9000 ANDERSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729
Mailing Address - Country:US
Mailing Address - Phone:512-331-9088
Mailing Address - Fax:512-918-9017
Practice Address - Street 1:9000 ANDERSON MILL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729
Practice Address - Country:US
Practice Address - Phone:512-331-9088
Practice Address - Fax:512-918-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty