Organization
LONE STAR PEDIATRIC DENTAL AND BRACES
Active
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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