1639597222 NPI number — AUSTIN CENTRAL PARK PEDIATRIC DENTISTRY

Table of content: LINDSAY KAYE MANNING LCSW (NPI 1760779193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639597222 NPI number — AUSTIN CENTRAL PARK PEDIATRIC DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN CENTRAL PARK PEDIATRIC DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639597222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 W 38TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-330-4624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 W 38TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-330-4624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
CRANDALL
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
512-330-4624

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  28784 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1619250123 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3194185-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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