Provider Demographics
NPI:1790127538
Name:LA FRONTERA DENTAL PLLC
Entity Type:Organization
Organization Name:LA FRONTERA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYANARAYANAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:THIRUMALAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-358-1215
Mailing Address - Street 1:2711 LA FRONTERA BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-8005
Mailing Address - Country:US
Mailing Address - Phone:512-358-1215
Mailing Address - Fax:512-358-1266
Practice Address - Street 1:2711 LA FRONTERA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8005
Practice Address - Country:US
Practice Address - Phone:512-358-1215
Practice Address - Fax:512-358-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty