Main Street Dental

NPI #1710561824 in Bastrop, Texas

Provider Information

NPI Number: 1710561824
Entity Type: Organization
Organization Name: Main Street Dental
Primary Specialty: Clinic/Center - Dental
Enumeration Date: May 6, 2021
Last Updated: May 6, 2021

Practice Location

Address: 812 CHESTNUT ST
City: Bastrop
State: Texas
ZIP Code: 78602-3205
Phone: (512) 985-6607

Authorized Official

Name: STACEY BARTLEY
Title: OWNER
Phone: (281) 744-5058

Specialties & Taxonomy Codes

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

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