Provider Demographics
NPI:1760938450
Name:SEGUIN DENTALCARE PLLC
Entity Type:Organization
Organization Name:SEGUIN DENTALCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANTKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:200-600-1782
Mailing Address - Street 1:1417 E WALNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5182
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1417 E WALNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5182
Practice Address - Country:US
Practice Address - Phone:201-600-1782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty