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General NPI Number Information
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NPI Number | 1508168121
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Entity Type | Organization
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Legal Business Name | NIA ORTHODINTICS PA
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 7112 ED BLUESTEIN BLVD 100
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City | AUSTIN
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State | TX
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Zip | 78723-2900
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Country | US
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Telephone | 512-583-9679
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Fax | 512-334-2321
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Provider Business Mailing Address
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Address Line | 2621 RIDGEPOINT DR 130
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City | AUSTIN
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State | TX
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Zip | 78754-5232
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Country | US
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Telephone | 512-583-9679
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Fax | 512-334-2321
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Authorized Official
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Title or Position | ORTHODONTIC
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Name | FARSHID NIA
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Credential | DR
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Telephone | 512-583-9679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0026146
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License Number State | TX
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