MEDICARE: DR. BRAD A THERIOT DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	13698	TX

General Provider Information

NPI Number	:	1649242132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD A THERIOT DDS

Provider Business Mailing Address
First Line	:	711 W 38TH ST
Second Line	:	SUITE A-1
City	:	AUSTIN
State	:	TX
Zip	:	78705-1121
Country	:	US
Telephone Number	:	512-454-1220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	SUITE 6B
City	:	AUSTIN
State	:	TX
Zip	:	78745-5281
Country	:	US
Telephone Number	:	512-447-6684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/04/2014

Similar Medicare Providers

1861128878 — YAMID OMAR MONTALVO LPC
Practice Location Address:

2501 W WILLIAM CANNON DR BLDG 4
AUSTIN, TX
78745-5281

Practice Phone: 512-804-3200
Practice Fax:

1174595664 — DR. JAMES C FUSELIER DDS MD
Practice Location Address:

2501 W WILLIAM CANNON DR , SUITE 6B
AUSTIN, TX
78745-5281

Practice Phone: 512-447-6684
Practice Fax:

1578505145 — STONEGATE PHARMACY LP
Practice Location Address:

2501 W WILLIAM CANNON DR , BLDG 2 STE 203
AUSTIN, TX
78745-5281

Practice Phone: 512-707-2300
Practice Fax: 512-707-2378

1184630030 — MS. PAMELA J STEELE MS MA LPC
Practice Location Address:

2501 W WILLIAM CANNON DR , SUITE 401
AUSTIN, TX
78745-5281

Practice Phone: 512-416-7246
Practice Fax: 512-275-2833

1316051709 — KRISTEN JEAN DEMERS PT
Practice Location Address:

2501 W WILLIAM CANNON DR , BLDG 1, STE 102
AUSTIN, TX
78745-5281

Practice Phone: 512-651-0301
Practice Fax: 512-651-0305

1396838488 — SHARON S. DICKMANN MPT
Practice Location Address:

2501 W WILLIAM CANNON DR , BLDG. 1, SUITE #102
AUSTIN, TX
78745-5281

Practice Phone: 512-651-0301
Practice Fax: 512-651-0305

Directions to “ DR. BRAD A THERIOT DDS” 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.