Provider Demographics
NPI:1285893651
Name:CENTRAL FAMILY DENTAL CENTER
Entity type:Organization
Organization Name:CENTRAL FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-473-8444
Mailing Address - Street 1:39 HEDGEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:THE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1319
Mailing Address - Country:US
Mailing Address - Phone:512-261-4676
Mailing Address - Fax:
Practice Address - Street 1:2719 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3907
Practice Address - Country:US
Practice Address - Phone:512-473-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009623201Medicaid