Provider Demographics
NPI:1295893378
Name:BARGATZE, HONEY SUE (DDS)
Entity type:Individual
Prefix:DR
First Name:HONEY
Middle Name:SUE
Last Name:BARGATZE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15222 FM 620 N APT 5109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5129
Mailing Address - Country:US
Mailing Address - Phone:615-364-3352
Mailing Address - Fax:
Practice Address - Street 1:TRAILS DENTAL GROUP AND ORTHODONTICS
Practice Address - Street 2:8300 FM 620 N BUILDING G STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726
Practice Address - Country:US
Practice Address - Phone:512-331-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX392111223G0001X
ALD-0006811-C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice