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General NPI Number Information
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NPI Number | 1932904141
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Entity Type | Organization
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Legal Business Name | WIDNER ELITE ORAL SURGERY
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1500 W 38TH ST STE 51
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City | AUSTIN
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State | TX
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Zip | 78731-6320
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Country | US
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Telephone | 512-452-3223
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Fax | 512-452-5245
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Provider Business Mailing Address
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Address Line | 1500 W 38TH ST STE 51
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City | AUSTIN
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State | TX
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Zip | 78731-6320
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Country | US
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Telephone | 512-452-3223
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | JOYCE STAPLES
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Credential |
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Telephone | 512-452-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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