MEDICARE: TEXAS PERIODONTISTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1467132159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PERIODONTISTS PC

Provider Business Mailing Address
First Line	:	12319 N MOPAC EXPY STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2648
Country	:	US
Telephone Number	:	512-222-5721
Fax Number	:

Provider Business Practice Location Address
First Line	:	12319 N MOPAC EXPY STE 160
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-2648
Country	:	US
Telephone Number	:	512-222-5721
Fax Number	:	512-309-5273

Authorized Official
Title or Position	:	MANAGER
Name	:	MELISSA DIXON
Credential	:
Telephone Number	:	512-222-5721

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	08/01/2023

Similar Medicare Providers

1013163260 — DR. SIDDHARTH GUPTA BDS,MS
Practice Location Address:

12319 N MOPAC EXPY STE 160
AUSTIN, TX
78758-2648

Practice Phone: 512-222-5721
Practice Fax:

1679254544 — SHIYAMALI SUNDARARAJAN
Practice Location Address:

12319 N MOPAC EXPY STE 160
AUSTIN, TX
78758-2648

Practice Phone: 512-222-5721
Practice Fax:

1699639039 — NICOLE MIKEL MALONE LMSW
Practice Location Address:

10505 S IH 35 APT 1835
AUSTIN, TX
78747-2648

Practice Phone: 918-200-8661
Practice Fax:

1598693053 — ELLEN MARTIN RN
Practice Location Address:

9016 LAUREL GROVE DR
AUSTIN, TX
78758-6610

Practice Phone: 512-923-1138
Practice Fax:

1538098967 — MAKING A DIFFERENCE COMMUNITY WELLNESS
Practice Location Address:

11119 ALTERRA PKWY APT 2282
AUSTIN, TX
78758-0034

Practice Phone: 662-800-4513
Practice Fax:

1326694464 — MS. KIMBERLY ANDERSON PA-C
Practice Location Address:

11801 DOMAIN BLVD STE 120
AUSTIN, TX
78758-3455

Practice Phone: 512-649-1004
Practice Fax: 512-572-5184

Directions to “TEXAS PERIODONTISTS PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.