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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