Provider Demographics
NPI:1306412416
Name:JESTER DENTAL PC
Entity Type:Organization
Organization Name:JESTER DENTAL PC
Other - Org Name:JESTER VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-966-3685
Mailing Address - Street 1:6507 JESTER BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8357
Mailing Address - Country:US
Mailing Address - Phone:512-418-9150
Mailing Address - Fax:
Practice Address - Street 1:6507 JESTER BLVD STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8357
Practice Address - Country:US
Practice Address - Phone:512-418-9150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-29
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental