=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386048726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELITE DENTISTRY II, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2014
-----------------------------------------------------
Last Update Date | 10/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 OLD FREDERICKSBURG RD STE D102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78749-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-892-9900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 OLD FREDERICKSBURG RD STE D102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78749-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-892-9900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/PROSTHODONIST
-----------------------------------------------------
Name | DR. DARIAN KAAR
-----------------------------------------------------
Credential | DDS, MSD, FACP
-----------------------------------------------------
Telephone | 512-892-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------