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General NPI Number Information
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NPI Number | 1598613093
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Entity Type | Organization
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Legal Business Name | FULL ARCH AUSTIN LLC
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 1221 W BEN WHITE BLVD STE 212A
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City | AUSTIN
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State | TX
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Zip | 78704-7002
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Country | US
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Telephone | 512-444-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 W BEN WHITE BLVD STE 212A
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City | AUSTIN
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State | TX
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Zip | 78704-7002
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Country | US
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Telephone | 512-444-1133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVAN MATTHYSSE
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Credential | DDS
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Telephone | 917-817-0803
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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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