Organization
PARMER LANE ORTHODONTICS PC
Active
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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