Provider Demographics
NPI:1962733188
Name:DRIPPING SPRINGS DENTAL CENTER, LLC
Entity type:Organization
Organization Name:DRIPPING SPRINGS DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-858-5243
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-1262
Mailing Address - Country:US
Mailing Address - Phone:512-858-5243
Mailing Address - Fax:512-858-9804
Practice Address - Street 1:2150 E HWY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4576
Practice Address - Country:US
Practice Address - Phone:512-858-5243
Practice Address - Fax:512-858-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty