Healthcare Provider Details

I. General information

NPI: 1679997910
Provider Name (Legal Business Name): JAMES VINCENT VENUTI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 NORTH INTERSTATE 35 SUITE # 1320
AUSTIN TX
78753-9725
US

IV. Provider business mailing address

12901 NORTH INTERSTATE 35 SUITE # 1320
AUSTIN TX
78753-9725
US

V. Phone/Fax

Practice location:
  • Phone: 512-990-8300
  • Fax:
Mailing address:
  • Phone: 512-990-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: