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General NPI Number Information
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NPI Number | 1124598917
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Entity Type | Organization
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Legal Business Name | SETON ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 901 W 38TH ST SUITE 410
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City | AUSTIN
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State | TX
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Zip | 78705
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Country | US
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Telephone | 512-992-1378
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Fax | 512-992-1379
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Provider Business Mailing Address
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Address Line | 1345 PHILOMENA ST STE 410.3
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City | AUSTIN
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State | TX
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Zip | 78723
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Country | US
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Telephone | 512-992-1378
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Fax | 512-992-1379
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Authorized Official
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Title or Position | VP/COO
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Name | CLAYTON CARSNER
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Credential |
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Telephone | 512-324-5846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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