Healthcare Provider Details

I. General information

NPI: 1659749810
Provider Name (Legal Business Name): SPECIALTY DENTAL PARTNERS OF AUSTIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 N QUINLAN PARK RD STE 201
AUSTIN TX
78732-6071
US

IV. Provider business mailing address

136 4TH ST N STE 201
ST PETERSBURG FL
33701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-7503
  • Fax: 512-266-6197
Mailing address:
  • Phone: 727-800-8026
  • Fax: 727-304-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21635
License Number StateTX

VIII. Authorized Official

Name: NANCY SCHIAPARELLI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 727-800-8040