Organization
SAM BASS FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUPA GOVINDARAJAN DMD (OWNER)
(951) 454-2716
Entity
Organization
Contact information
Practice address
2000 SAM BASS RD STE 108, ROUND ROCK, TX 78681-2001
(512) 341-3200
Mailing address
2000 SAM BASS RD STE 108, ROUND ROCK, TX 78681-2001
(512) 341-3200
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12455101016
—
TX
Enumeration date
04/20/2015
Last updated
04/20/2015
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