Healthcare Provider Details

I. General information

NPI: 1073611273
Provider Name (Legal Business Name): MARC AMSILI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W WILLIAM CANNON DR SUITE 401
AUSTIN TX
78745-5468
US

IV. Provider business mailing address

1110 W WILLIAM CANNON DR SUITE 401
AUSTIN TX
78745-5468
US

V. Phone/Fax

Practice location:
  • Phone: 512-445-5012
  • Fax: 512-445-5721
Mailing address:
  • Phone: 512-445-5012
  • Fax: 512-445-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16471
License Number StateTX

VIII. Authorized Official

Name: DR. MARC A AMSILI
Title or Position: OWNER
Credential: DDS, PA
Phone: 512-250-5012