Provider Demographics
NPI:1427761196
Name:FOUR POINTS DENTAL GROUP PLLC
Entity type:Organization
Organization Name:FOUR POINTS DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:WALDSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-722-1083
Mailing Address - Street 1:7301 N FM 620 RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4538
Mailing Address - Country:US
Mailing Address - Phone:512-872-2222
Mailing Address - Fax:512-250-2902
Practice Address - Street 1:7301 N FM 620 RD STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4538
Practice Address - Country:US
Practice Address - Phone:512-872-2222
Practice Address - Fax:512-250-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental