Healthcare Provider Details

I. General information

NPI: 1942171681
Provider Name (Legal Business Name): YIWEI GAO DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 S 1ST ST STE 103
AUSTIN TX
78745-4052
US

IV. Provider business mailing address

3818 FAR WEST BLVD STE 111
AUSTIN TX
78731-3050
US

V. Phone/Fax

Practice location:
  • Phone: 512-222-9772
  • Fax:
Mailing address:
  • Phone: 512-345-1140
  • Fax: 512-345-1986

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: YIWEI GAO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 512-345-1140