Lone Star Pediatric Dental And Braces
Dentist, Orthodontics and Dentofacial Orthopedics in Austin, TX. Organization (NPI-2).
Details
- NPI
- 1124464813
- Entity type
- Organization (NPI-2)
- Legal business name
- Lone Star Pediatric Dental And Braces
- Organization subpart
- No
- Enumeration date
- May 21, 2013
- Last updated
- Dec 5, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | 24217 | TX | Yes |
Practice location
4201 Marathon Blvd302
Austin, TX 78756-3436
Phone 512-206-2929
Mailing address
4201 Marathon Blvd302
Austin, TX 78756-3436
Phone 512-206-2929
Authorized official
Marty Montgomery
Owner
5124208889
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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