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General NPI Number Information
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NPI Number | 1336603273
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Entity Type | Organization
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Legal Business Name | STASSNEY AUSTIN DENTAL PLLC
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 5717 S INTERSTATE 35 STE 101
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City | AUSTIN
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State | TX
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Zip | 78744-2711
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Country | US
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Telephone | 512-462-4775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734753
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City | DALLAS
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State | TX
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Zip | 75373-4753
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Country | US
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Telephone | 972-869-3789
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 630-877-3520
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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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