Provider Demographics
NPI:1427449966
Name:ROUND ROCK COMFORT DENTISTRY
Entity type:Organization
Organization Name:ROUND ROCK COMFORT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAGARAJU RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:INDRAKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-435-0648
Mailing Address - Street 1:1715 S MAYS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6740
Mailing Address - Country:US
Mailing Address - Phone:512-248-8888
Mailing Address - Fax:512-733-0000
Practice Address - Street 1:1715 S MAYS ST
Practice Address - Street 2:SUITE E
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6740
Practice Address - Country:US
Practice Address - Phone:512-248-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty