Provider Demographics
NPI:1174816078
Name:DESSAU FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DESSAU FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-251-3331
Mailing Address - Street 1:1508 DESSAU RIDGE LN
Mailing Address - Street 2:SUITE#604
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-2119
Mailing Address - Country:US
Mailing Address - Phone:512-251-3331
Mailing Address - Fax:512-318-2481
Practice Address - Street 1:1508 DESSAU RIDGE LN
Practice Address - Street 2:SUITE#604
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-2119
Practice Address - Country:US
Practice Address - Phone:512-251-3331
Practice Address - Fax:512-318-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty