1326233818 NPI number — TEXAS SMILES DENTAL CENTER OF AUSTIN, PLLC

Table of content: (NPI 1326233818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326233818 NPI number — TEXAS SMILES DENTAL CENTER OF AUSTIN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS SMILES DENTAL CENTER OF AUSTIN, PLLC
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:
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:
1326233818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W 8TH ST
Provider Second Line Business Mailing Address:
SUITE 810
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81003-3038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-562-4447
Provider Business Mailing Address Fax Number:
719-583-1801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W WILLIAM CANNON DR
Provider Second Line Business Practice Location Address:
SUITE 438-A
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-329-5437
Provider Business Practice Location Address Fax Number:
512-326-5439
Provider Enumeration Date:
09/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRINGER
Authorized Official First Name:
JENELL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, LICENSING & CREDENTIALING
Authorized Official Telephone Number:
615-750-0343

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 187592401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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