Healthcare Provider Details

I. General information

NPI: 1558299545
Provider Name (Legal Business Name): TRU DENTISTRY SOCO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S CONGRESS AVE STE F
AUSTIN TX
78704-6463
US

IV. Provider business mailing address

3100 S CONGRESS AVE STE F
AUSTIN TX
78704-6463
US

V. Phone/Fax

Practice location:
  • Phone: 512-737-7029
  • Fax: 512-737-7026
Mailing address:
  • Phone: 512-737-7029
  • Fax: 512-737-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE KOSTIUK
Title or Position: OWNER
Credential: DMD
Phone: 941-875-7002