MEDICARE: TB AUSTIN GPS 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

General Provider Information

NPI Number	:	1841157815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TB AUSTIN GPS PLLC

Provider Business Mailing Address
First Line	:	211 WALTER SEAHOLM DR STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-0020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 WALTER SEAHOLM DR STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-0020
Country	:	US
Telephone Number	:	512-949-8202
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAUREN JACOBSEN
Credential	:	DMD
Telephone Number	:	512-949-8202

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	04/14/2026

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