Provider Demographics
NPI:1023360773
Name:AUSTIN HJ DENTAL PC
Entity Type:Organization
Organization Name:AUSTIN HJ DENTAL PC
Other - Org Name:TEXAS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-257-2828
Mailing Address - Street 1:13048 RESEARCH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3205
Mailing Address - Country:US
Mailing Address - Phone:512-257-2828
Mailing Address - Fax:
Practice Address - Street 1:13048 RESEARCH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3205
Practice Address - Country:US
Practice Address - Phone:512-257-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty