Provider Demographics
NPI:1235508789
Name:TINA'S TINY TEXANS
Entity type:Organization
Organization Name:TINA'S TINY TEXANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-646-4500
Mailing Address - Street 1:2912 LYNNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2124
Mailing Address - Country:US
Mailing Address - Phone:512-646-4500
Mailing Address - Fax:512-646-4501
Practice Address - Street 1:11200 MANCHACA RD
Practice Address - Street 2:BUILDING 4, SUITE 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-646-4500
Practice Address - Fax:512-646-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty