Healthcare Provider Details

I. General information

NPI: 1275922429
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES OF AUSTIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 N CENTRAL EXPY 1014
DALLAS TX
75243-1700
US

IV. Provider business mailing address

4310 MEDICAL PKWY 203
AUSTIN TX
78756-3335
US

V. Phone/Fax

Practice location:
  • Phone: 214-342-0425
  • Fax:
Mailing address:
  • Phone: 512-459-3129
  • Fax: 512-459-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number20123
License Number StateTX

VIII. Authorized Official

Name: YOGESH T PATEL
Title or Position: OWNER/PRESIDENT
Credential: D.D.S.
Phone: 214-342-0425