Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 24993 | TX |
Y | 1223G0001X | General Practice | 24993 | TX |
Y | 213EG0000X | General Practice | 24993 | TX |
NPI | 1003149287 |
---|---|
Provider Name | Aleksandar Todorov Gavrilov |
First Address | Cedar Park, TX 78613-7635 |
Second Address | Leander, TX 78641-1934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2009 |
Last Update Date | 30/11/2016 |