Provider Demographics
NPI:1477700300
Name:IMAGDENT AUSTIN LP
Entity Type:Organization
Organization Name:IMAGDENT AUSTIN LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMAGING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-795-9950
Mailing Address - Street 1:7800 N MOPAC EXPY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8900
Mailing Address - Country:US
Mailing Address - Phone:512-795-9950
Mailing Address - Fax:512-795-9951
Practice Address - Street 1:7800 N MOPAC EXPY
Practice Address - Street 2:SUITE 115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8900
Practice Address - Country:US
Practice Address - Phone:512-795-9950
Practice Address - Fax:512-795-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty