Healthcare Provider Details

I. General information

NPI: 1124441530
Provider Name (Legal Business Name): ESWAR KERAN CHANDRA DAMODARA BDS., MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAM CANNON DR STE 201
AUSTIN TX
78745-6671
US

IV. Provider business mailing address

801 E WILLIAM CANNON DR STE 201
AUSTIN TX
78745-6671
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-5714
  • Fax:
Mailing address:
  • Phone: 512-717-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number29259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: