Provider Demographics
NPI:1184909814
Name:LIBERTY HILL PEDIATRIC DENTISTRY, PA
Entity type:Organization
Organization Name:LIBERTY HILL PEDIATRIC DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-293-5664
Mailing Address - Street 1:9415 W STATE HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6914
Mailing Address - Country:US
Mailing Address - Phone:512-930-4040
Mailing Address - Fax:
Practice Address - Street 1:9415 W STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6914
Practice Address - Country:US
Practice Address - Phone:512-930-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty