Provider Demographics
NPI:1972173342
Name:COUNTY LINE DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:COUNTY LINE DENTAL PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-990-9903
Mailing Address - Street 1:1187 WEST COUNTY LINE ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:210-990-9903
Mailing Address - Fax:
Practice Address - Street 1:1187 WEST COUNTY LINE ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:210-990-9903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental