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General NPI Number Information
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NPI Number | 1245827096
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Entity Type | Organization
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Legal Business Name | AUSTIN PERIODONTICS PA
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 8200 N MOPAC EXPY STE 120
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City | AUSTIN
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State | TX
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Zip | 78759-8845
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Country | US
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Telephone | 512-863-9500
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Fax | 512-863-9562
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Provider Business Mailing Address
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Address Line | 8200 N MOPAC EXPY STE 120
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City | AUSTIN
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State | TX
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Zip | 78759-8845
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Country | US
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Telephone | 512-863-9500
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Fax | 512-863-9562
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JONATHAN CALLIA
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Credential | DDS, MS
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Telephone | 512-589-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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