Provider Demographics
NPI:1962837989
Name:ANN E DIMICK PEDIATRIC DENTISTRY PC
Entity type:Organization
Organization Name:ANN E DIMICK PEDIATRIC DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DIMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:512-762-1444
Mailing Address - Street 1:12101 BEE CAVE RD
Mailing Address - Street 2:STE 1B
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738
Mailing Address - Country:US
Mailing Address - Phone:512-762-1444
Mailing Address - Fax:
Practice Address - Street 1:12101 BEE CAVES RD
Practice Address - Street 2:1B
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-5391
Practice Address - Country:US
Practice Address - Phone:512-762-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22509261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental