Organization
SPECIALTY PEDIATRIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERENTHES FIELDS (CREDENTIALING SPECIALIST)
(678) 599-2333
Entity
Organization
Contact information
Practice address
3313 RANCH ROAD 620 S STE 300, LAKEWAY, TX 78738-6871
(512) 266-7200
(512) 233-5180
Mailing address
1500 S A W GRIMES BLVD STE 190, ROUND ROCK, TX 78664-7843
(512) 266-7200
(512) 233-5180
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/30/2023
Last updated
03/30/2023
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