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General NPI Number Information
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NPI Number | 1639189871
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Entity Type | Organization
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Legal Business Name | ADVANCED SMILES DENTAL, PA
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 8715 W. PARMER LANE BLDG #2; SUITE #100
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City | AUSTIN
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State | TX
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Zip | 78729
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Country | US
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Telephone | 512-258-3384
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Fax | 512-258-9433
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Provider Business Mailing Address
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Address Line | 8715 W. PARMER LANE BLDG #2; SUITE #100
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City | AUSTIN
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State | TX
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Zip | 78729
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Country | US
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Telephone | 512-258-3384
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Fax | 512-258-9433
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. JULIE A EIVENS
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Credential | DDS
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Telephone | 512-258-3384
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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 | 18720
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18642
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License Number State | TX
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