# FOSSIL DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WALTER D. THAMES, PLLC
- **Other names:** Fossil Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164125456
- **Legal business name:** WALTER D. THAMES, PLLC
- **Authorized official:** DR. WALTER D THAMES DDS, MS (OWNER/DENTIST)
- **Authorized official phone:** (210) 888-5832

## Contact information

- **Practice address:** 8142 SHIN OAK DR STE 100, LIVE OAK, TX 78233-2775
- **Practice address phone:** (210) 888-5832
- **Mailing address:** 8142 SHIN OAK DR STE 100, LIVE OAK, TX 78233-2775
- **Mailing address phone:** (210) 888-5832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/24/2023
- **Last updated:** 03/24/2023