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General NPI Number Information
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NPI Number | 1639597222
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Entity Type | Organization
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Legal Business Name | AUSTIN CENTRAL PARK PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1005 W 38TH ST STE 200
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City | AUSTIN
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State | TX
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Zip | 78705-1042
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Country | US
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Telephone | 512-330-4624
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 W 38TH ST STE 200
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City | AUSTIN
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State | TX
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Zip | 78705-1042
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Country | US
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Telephone | 512-330-4624
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DANIEL CRANDALL JOHNSON
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Credential | DDS
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Telephone | 512-330-4624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 28784
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License Number State | TX
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