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General NPI Number Information
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NPI Number | 1659725349
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Entity Type | Organization
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Legal Business Name | ATX DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 3100 S CONGRESS AVE # 1F
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City | AUSTIN
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State | TX
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Zip | 78704-6427
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Country | US
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Telephone | 512-240-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 S CONGRESS AVE # 1F
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City | AUSTIN
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State | TX
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Zip | 78704-6427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VICTORIA GUTWEIN
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Credential |
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Telephone | 512-340-6054
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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 | 30301
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License Number State | TX
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