Healthcare Provider Details

I. General information

NPI: 1518479534
Provider Name (Legal Business Name): FEDERICO JOSE PIGEM GASOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 HYMEADOW DR
AUSTIN TX
78750-1934
US

IV. Provider business mailing address

51 RAINEY ST
AUSTIN TX
78701-4401
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-5012
  • Fax:
Mailing address:
  • Phone: 310-948-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number33575
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number33575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: