| NPI | 1821341660 |
|---|---|
| Other Name | ROUND ROCK, PARK VALLEY DRIVE SPECIALTY |
| Entity Type | Organization |
| Authorized Contact | MALCOLM RAY SCOTT President 512-371-1222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 15919) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 21209) |
| 1223E0200X Dentist, Endodontics (Licence: TX 25659) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22831) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |