Provider Demographics
NPI:1326257858
Name:DENTAL CENTER OF SOUTH AUSTIN, P.C.
Entity Type:Organization
Organization Name:DENTAL CENTER OF SOUTH AUSTIN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGNOLIA
Authorized Official - Middle Name:MAGGIE
Authorized Official - Last Name:SHARFAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-288-0400
Mailing Address - Street 1:7010 W HIGHWAY 71
Mailing Address - Street 2:STE 225
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8300
Mailing Address - Country:US
Mailing Address - Phone:512-288-0400
Mailing Address - Fax:512-288-0482
Practice Address - Street 1:7010 W HIGHWAY 71
Practice Address - Street 2:STE 225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8300
Practice Address - Country:US
Practice Address - Phone:512-288-0400
Practice Address - Fax:512-288-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty