Healthcare Provider Details

I. General information

NPI: 1639089881
Provider Name (Legal Business Name): NORTHWEST ENDODONTICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11671 JOLLYVILLE RD STE 201
AUSTIN TX
78759-4141
US

IV. Provider business mailing address

11671 JOLLYVILLE RD STE 201
AUSTIN TX
78759-4141
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-7668
  • Fax:
Mailing address:
  • Phone: 512-249-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MICHAELA MUNIZ
Title or Position: VP, PAYOR RELATIONS
Credential:
Phone: 469-324-3242