Provider Demographics
NPI:1275922429
Name:ENDODONTIC ASSOCIATES OF AUSTIN, PLLC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF AUSTIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-342-0425
Mailing Address - Street 1:4310 MEDICAL PKWY
Mailing Address - Street 2:203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3335
Mailing Address - Country:US
Mailing Address - Phone:512-459-3129
Mailing Address - Fax:512-459-3431
Practice Address - Street 1:12655 N CENTRAL EXPY
Practice Address - Street 2:1014
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1700
Practice Address - Country:US
Practice Address - Phone:214-342-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty