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General NPI Number Information
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NPI Number | 1891205290
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Entity Type | Organization
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Legal Business Name | QUINTESSENCE PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 6611 RIVER PLACE BLVD STE 201
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City | AUSTIN
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State | TX
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Zip | 78730-1167
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Country | US
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Telephone | 512-777-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 RIVER PLACE BLVD STE 201
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City | AUSTIN
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State | TX
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Zip | 78730-1167
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Country | US
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Telephone | 512-777-2969
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Fax | 512-777-0861
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Authorized Official
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Title or Position | PRESIDENT
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Name | AISAH WHITE
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Credential | MD
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Telephone | 512-777-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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