My Local Texas Dental Practice, Pllc

NPI #1043887953 in Boerne, Texas

Provider Information

NPI Number
1043887953
Entity Type
Organization
Organization Name
My Local Texas Dental Practice, Pllc
Subpart
Yes (part of a larger organization)
Parent Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Primary Specialty
Dentist - General Practice
Enumeration Date
Jun 9, 2021
Last Updated
Jun 9, 2021

Practice Location

Address
804 N MAIN ST
City
Boerne
State
Texas
ZIP Code
78006-1626
Phone
(830) 249-8407

Authorized Official

Name
MICHELLE JOHNSON
Title
CREDENTIALING SPECIALIST
Phone
(509) 315-8338

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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