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General NPI Number Information
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NPI Number | 1114860335
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Entity Type | Organization
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Legal Business Name | WELLSIDE HEALTH PLLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 3410 FAR WEST BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78731-3272
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Country | US
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Telephone | 512-596-1140
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Fax | 512-727-0556
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Provider Business Mailing Address
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Address Line | 7301 MOON ROCK RD
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City | AUSTIN
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State | TX
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Zip | 78739-2233
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Country | US
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Telephone | 512-596-1140
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Fax | 512-727-0556
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRIDUL CHAKARVARTY
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Credential |
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Telephone | 512-596-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number |
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License Number State |
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