Provider Demographics
NPI:1417485244
Name:EAST AUSTIN DENTAL
Entity Type:Organization
Organization Name:EAST AUSTIN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-499-0067
Mailing Address - Street 1:1000 E 5TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3802
Mailing Address - Country:US
Mailing Address - Phone:512-499-0067
Mailing Address - Fax:844-270-5426
Practice Address - Street 1:1000 E 5TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3802
Practice Address - Country:US
Practice Address - Phone:512-499-0067
Practice Address - Fax:844-270-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28126261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental