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General NPI Number Information
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NPI Number | 1477700300
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Entity Type | Organization
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Legal Business Name | IMAGDENT AUSTIN LP
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 7800 N MOPAC EXPY SUITE 115
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City | AUSTIN
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State | TX
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Zip | 78759-8900
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Country | US
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Telephone | 512-795-9950
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Fax | 512-795-9951
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Provider Business Mailing Address
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Address Line | 7800 N MOPAC EXPY SUITE 115
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City | AUSTIN
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State | TX
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Zip | 78759-8900
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Country | US
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Telephone | 512-795-9950
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Fax | 512-795-9951
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Authorized Official
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Title or Position | IMAGING COORDINATOR
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Name | MELISSA DELEON
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Credential |
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Telephone | 512-795-9950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number |
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License Number State |
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