Provider Demographics
NPI:1891039491
Name:SPICEWOOD SPRINGS DENTAL CENTER
Entity Type:Organization
Organization Name:SPICEWOOD SPRINGS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:JIN-MEI
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-250-9603
Mailing Address - Street 1:8650 SPICEWOOD SPRINGS RD STE 214
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4318
Mailing Address - Country:US
Mailing Address - Phone:512-250-9603
Mailing Address - Fax:
Practice Address - Street 1:8650 SPICEWOOD SPRINGS RD STE 214
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4318
Practice Address - Country:US
Practice Address - Phone:512-250-9603
Practice Address - Fax:512-250-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty