Healthcare Provider Details

I. General information

NPI: 1720195498
Provider Name (Legal Business Name): AUSTIN PERIODONTAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 N MOPAC SUITE 310
AUSTIN TX
78759
US

IV. Provider business mailing address

7800 N MOPAC SUITE 310
AUSTIN TX
78759-8961
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-6097
  • Fax: 512-346-8135
Mailing address:
  • Phone: 512-346-6097
  • Fax: 512-346-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7673
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20256
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16531
License Number StateTX

VIII. Authorized Official

Name: DR. CHARLES LEONARD DOLCE
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 512-346-6097