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General NPI Number Information
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NPI Number | 1265765234
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTISTRY OF AUSTIN
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 3801 BEE CAVES RD STE. 120
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City | AUSTIN
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State | TX
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Zip | 78746-6657
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Country | US
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Telephone | 512-215-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 BEE CAVES RD. STE. 120
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-215-9242
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BILLY J. METCALF
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Credential | D.D.S.
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Telephone | 512-215-9242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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