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General NPI Number Information
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NPI Number | 1811634561
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Entity Type | Organization
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Legal Business Name | AISHANI DENTAL PLLC DBA AUSTIN PRIMARY DENTAL
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Dates
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Enumeration Date | 05/15/2022
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Last Update Date | 05/15/2022
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Provider Practice Location Address
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Address Line | 6700 W GATE BLVD STE 103
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City | AUSTIN
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State | TX
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Zip | 78745-4867
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Country | US
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Telephone | 512-440-1333
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Fax | 512-440-0484
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Provider Business Mailing Address
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Address Line | 10900 GAILLARDIA
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City | AUSTIN
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State | TX
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Zip | 78733-5760
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Country | US
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Telephone | 512-705-4906
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. RUPA RAJANNA
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Credential | DMD
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Telephone | 512-705-4906
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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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