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Organization
QUINLAN PARK DENTAL
Active
Organization
QUINLAN PARK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUMITA CHAKRABORTI (OWNER)
(512) 619-3514
Entity
Organization
Contact information
Practice address
5145 N. FM 620 SUITE G-150, AUSTIN, TX 78732
(512) 619-3514
Mailing address
5145 N. FM 620 SUITE G-150, AUSTIN, TX 78732
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
23056
TX
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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