Provider Demographics
NPI:1174621759
Name:ALBERT M. TATE, JR. D.D.S.;P.A.
Entity type:Organization
Organization Name:ALBERT M. TATE, JR. D.D.S.;P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:MILNER
Authorized Official - Last Name:TATE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS;PA
Authorized Official - Phone:512-342-7805
Mailing Address - Street 1:11149 RESEARCH BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5279
Mailing Address - Country:US
Mailing Address - Phone:512-342-7805
Mailing Address - Fax:512-502-9689
Practice Address - Street 1:11149 RESEARCH BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5279
Practice Address - Country:US
Practice Address - Phone:512-342-7805
Practice Address - Fax:512-502-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty