Provider Demographics
NPI:1740624634
Name:IBTH DENTAL PLLC/KROMMENHOEK AND HANLE, D.D.S
Entity type:Organization
Organization Name:IBTH DENTAL PLLC/KROMMENHOEK AND HANLE, D.D.S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KROMMENHOEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-327-6908
Mailing Address - Street 1:6341 SPANISH OAKS CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6040
Mailing Address - Country:US
Mailing Address - Phone:512-327-6908
Mailing Address - Fax:512-327-6695
Practice Address - Street 1:4105 WESTBANK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4455
Practice Address - Country:US
Practice Address - Phone:512-327-6908
Practice Address - Fax:512-327-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty