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General NPI Number Information
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NPI Number | 1972171932
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Entity Type | Organization
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Legal Business Name | KIDS TOOTH TEAM SOUTH AUSTIN PLLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 1217 W SLAUGHTER LN STE 140
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City | AUSTIN
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State | TX
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Zip | 78748-6916
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Country | US
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Telephone | 512-523-4774
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Fax | 512-355-7030
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Provider Business Mailing Address
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Address Line | 1245 MAIN ST STE 300
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City | BUDA
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State | TX
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Zip | 78610-2269
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Country | US
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Telephone | 512-523-4774
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Fax | 512-355-7030
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALEXANDRA BARTON OTTO
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Credential | DDS
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Telephone | 239-293-0387
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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 |
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License Number State |
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