Individual
SUBASH MUTYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1500 A W GRIMES BLVD, STE 130, ROUND ROCK, TX 78664-7836
(512) 238-7300
(512) 238-7301
Mailing address
1500 A W GRIMES BLVD, STE 130, ROUND ROCK, TX 78664-7836
(512) 238-7300
(512) 238-7301
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
23436
TX
Other
Enumeration date
08/14/2007
Last updated
02/16/2010
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