Healthcare Provider Details

I. General information

NPI: 1669547832
Provider Name (Legal Business Name): MARC A AMSILI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 HYMEADOW DR SUITE 250
AUSTIN TX
78750-1934
US

IV. Provider business mailing address

12335 HYMEADOW DR SUITE 250
AUSTIN TX
78750-1934
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-5012
  • Fax: 512-219-8510
Mailing address:
  • Phone: 512-250-5012
  • Fax: 512-219-8510

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:
Title or Position:
Credential:
Phone: