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Search › Texas › 235Z00000X

Mary Mellencamp

NPI 1295394088 · on the registry since 2019

Practice

Address
4402 Williams Dr Ste 115
Georgetown, TX 78628
Phone
(832) 655-3754
Organisation at this address
Jacqueline Kozak
Torres Dental Specialties Pllc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
42

Registry record

Primary taxonomy
235Z00000X
235Z00000X
Licence states on file
TX
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2023-11-27

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas