Provider Demographics
NPI:1306023957
Name:CENETRON DIAGNOSTICS, LTD
Entity Type:Organization
Organization Name:CENETRON DIAGNOSTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-439-2000
Mailing Address - Street 1:2111 W BRAKER LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4029
Mailing Address - Country:US
Mailing Address - Phone:512-439-2000
Mailing Address - Fax:512-439-5006
Practice Address - Street 1:2111 W BRAKER LN
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4029
Practice Address - Country:US
Practice Address - Phone:512-439-2000
Practice Address - Fax:512-439-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6929291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory