Basic Information
| Provider Information | |||||||||
| NPI: | 1023453677 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NW DENTISTRY AND ORTHODONTICS, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHWEST AUSTIN DENTISTS AND ORTHODONTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17000 RED HILL AVE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926145626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148458890 | ||||||||
| FaxNumber: | 7148458803 | ||||||||
| Practice Location | |||||||||
| Address1: | 14028 NORTH US HIGHWAY 183 | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122583878 | ||||||||
| FaxNumber: | 5122583322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2013 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | BARNES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DDS/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5122583878 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.