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General NPI Number Information
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NPI Number | 1174829162
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Entity Type | Organization
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Legal Business Name | AUSTIN MODERN DENTISTRY, PC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 3601 W WILLIAM CANNON DR BLDG 4
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City | AUSTIN
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State | TX
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Zip | 78749-1533
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Country | US
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Telephone | 512-892-0817
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Fax | 512-899-2111
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE FL 2
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City | IRVINE
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State | CA
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Zip | 92606-1008
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | CONTRACTS ADMIN
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Name | DR. JOHN S BARNES
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Credential | DDS
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Telephone | 512-892-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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