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General NPI Number Information
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NPI Number | 1508875147
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Entity Type | Organization
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Legal Business Name | AUSTIN ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 711 W 38TH ST SUITE A-1
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City | AUSTIN
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State | TX
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Zip | 78705-1121
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Country | US
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Telephone | 512-454-1220
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Fax | 512-467-0363
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Provider Business Mailing Address
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Address Line | 711 W 38TH ST SUITE A-1
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City | AUSTIN
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State | TX
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Zip | 78705-1121
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Country | US
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Telephone | 512-454-1220
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Fax | 512-467-0363
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Authorized Official
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Title or Position | MANAGED CARE COORDINATOR
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Name | MS. JANICE MARIE ASHTON
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Credential |
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Telephone | 512-454-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | TX
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