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Organization
ANDERSON LANE DENTAL CENTER PLLC
Active
Organization
ANDERSON LANE DENTAL CENTER PLLC
Active
Other names
ANDERSON LANE DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD BERNARD PEVOW DMD (OWNER)
(512) 459-4347
Entity
Organization
Contact information
Practice address
1802 W ANDERSON LN, AUSTIN, TX 78757-1338
(512) 459-4347
(512) 459-4348
Mailing address
1802 W ANDERSON LN, AUSTIN, TX 78757-1338
(512) 459-4347
(512) 459-4348
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
28268
TX
Other
Enumeration date
01/02/2014
Last updated
01/02/2014
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