Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0025482 | TX |
Y | 1223P0300X | Periodontist | 25482 | TX |
NPI | 1093035966 |
---|---|
Provider Name | Dr. Andrew David Verrett |
First Address | Austin, TX 78759-8961 |
Second Address | Austin, TX 78759-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 08/04/2020 |