MEDICARE: PRESTIGE DENTAL AUSTIN, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29475	TX

General Provider Information

NPI Number	:	1437669538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE DENTAL AUSTIN, PLLC

Provider Business Mailing Address
First Line	:	9300 SPRING HOLLOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-2929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S CAPITAL OF TEXAS HWY STE 220
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-4305
Country	:	US
Telephone Number	:	512-327-8645
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	VINCENT HO
Credential	:	DDS
Telephone Number	:	415-827-2381

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

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