Organization
PARMER LANE ORTHODONTICS PC
Active
Other names
Parmer Lane Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIP DESAI DDS (OWNER)
(517) 793-9325
Entity
Organization
Contact information
Practice address
2121 W PARMER LN STE 111, AUSTIN, TX 78727-4360
(512) 793-9325
Mailing address
2121 W PARMER LN STE 111, AUSTIN, TX 78727-4360
(512) 793-9325
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30390
STATE LICENSE
TX
Enumeration date
07/11/2018
Last updated
07/11/2018
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