Fossil Dental

NPI #1164125456 in Live Oak, Texas

Provider Information

NPI Number: 1164125456
Entity Type: Organization
Organization Name: Fossil Dental
Subpart: Yes (part of a larger organization)
Parent Organization: WALTER D. THAMES, PLLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Mar 24, 2023
Last Updated: Mar 24, 2023

Practice Location

Address: 8142 SHIN OAK DR STE 100
City: Live Oak
State: Texas
ZIP Code: 78233-2775
Phone: (210) 888-5832

Authorized Official

Name: DR. WALTER D THAMES, DDS, MS
Title: OWNER/DENTIST
Phone: (210) 888-5832

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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