My Local Texas Dental Practice, Pllc

NPI #1689241598 in Lockhart, Texas

Provider Information

NPI Number: 1689241598
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: 701 STATE PARK RD
City: Lockhart
State: Texas
ZIP Code: 78644-4934
Phone: (512) 398-4934

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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