Elgin Pediatric Dental PLLC
Organization Active NPI Pediatric Dentistry · Elgin, TX
NPI 1235587700 · NPPES record last updated May 25, 2016
Key facts
- NPI
- 1235587700
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- 24217 (TX)
- Legal business name
- ELGIN PEDIATRIC DENTAL PLLC
- Practice address
- 250 W US Highway 290 # a
Elgin, TX 78621-3206 - Phone
- (512) 676-4444
- NPI assigned
- May 25, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Marty Montgomery, DDS
- Title
- Dentist/Owner
- Phone
- (512) 676-4444
Practitioners 1
-
Diana Tina DO Mayo, DDS
National Provider Directory
Locations
250 Highway 290 W
#A
Elgin, TX 78621
Phone (512) 676-4444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry |
1223P0221X | 24217 | TX | Yes |
Addresses
Primary practice location
250 W US Highway 290 # a
Elgin, TX 78621-3206
Mailing address
505 E Huntland Dr Ste 340
Austin, TX 78752-3745
Other names
- Lone Star Pediatric Dental
Other providers in Elgin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.