Provider Demographics
NPI:1154494250
Name:360 DENTAL CARE P.A.
Entity Type:Organization
Organization Name:360 DENTAL CARE P.A.
Other - Org Name:MICHAEL B. NUSSBAUM D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-327-3631
Mailing Address - Street 1:3660 STONERIDGE RD STE B101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7759
Mailing Address - Country:US
Mailing Address - Phone:512-327-3631
Mailing Address - Fax:512-327-2234
Practice Address - Street 1:3660 STONERIDGE RD STE B101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7759
Practice Address - Country:US
Practice Address - Phone:512-327-3631
Practice Address - Fax:512-327-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty