Provider Demographics
NPI:1174829162
Name:AUSTIN MODERN DENTISTRY, PC
Entity Type:Organization
Organization Name:AUSTIN MODERN DENTISTRY, PC
Other - Org Name:AUSTIN MODERN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-892-0817
Mailing Address - Street 1:2860 MICHELLE FL 2
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1008
Mailing Address - Country:US
Mailing Address - Phone:714-368-2077
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:3601 W WILLIAM CANNON DR BLDG 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1533
Practice Address - Country:US
Practice Address - Phone:512-892-0817
Practice Address - Fax:512-899-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty