Healthcare Provider Details

I. General information

NPI: 1144520859
Provider Name (Legal Business Name): AUSTIN RIVERSIDE - DR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 E RIVERSIDE DR BLDG 2 STE C
AUSTIN TX
78741-1324
US

IV. Provider business mailing address

2515 MCKINNEY AVE SUITE 940
DALLAS TX
75201-1908
US

V. Phone/Fax

Practice location:
  • Phone: 512-264-7300
  • Fax:
Mailing address:
  • Phone: 972-747-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SON TRAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 972-747-1400