Organization
LONE STAR PEDIATRIC DENTAL AND BRACES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY MONTGOMERY D.M.D. (OWNER)
(512) 420-8889
Entity
Organization
Contact information
Practice address
4201 MARATHON BLVD, 302, AUSTIN, TX 78756-3436
(512) 206-2929
Mailing address
4201 MARATHON BLVD, 302, AUSTIN, TX 78756-3436
(512) 206-2929
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
24217
TX
Other
Enumeration date
05/21/2013
Last updated
12/05/2013
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