Provider Demographics
NPI:1982293023
Name:T H WINDERMERE DENTAL CARE
Entity Type:Organization
Organization Name:T H WINDERMERE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-640-4090
Mailing Address - Street 1:3115 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5803
Mailing Address - Country:US
Mailing Address - Phone:512-640-4090
Mailing Address - Fax:512-640-4090
Practice Address - Street 1:3115 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5803
Practice Address - Country:US
Practice Address - Phone:512-640-4090
Practice Address - Fax:512-640-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35373OtherDENTIST