1619220811 NPI number — MICHAEL ALLEN CIAVERELLI, DDS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619220811 NPI number — MICHAEL ALLEN CIAVERELLI, DDS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL ALLEN CIAVERELLI, DDS, P.A.
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:
1619220811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4029 S CAPITAL OF TEXAS HWY
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-7927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-445-5866
Provider Business Mailing Address Fax Number:
512-445-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4029 S CAPITAL OF TEXAS HWY
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-445-5866
Provider Business Practice Location Address Fax Number:
512-445-4262
Provider Enumeration Date:
10/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CIAVERELLI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-445-5866

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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