Provider Demographics
NPI:1487201398
Name:INN DENTAL PLLC
Entity Type:Organization
Organization Name:INN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-327-6947
Mailing Address - Street 1:3920 AGAPE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1660
Mailing Address - Country:US
Mailing Address - Phone:512-327-6947
Mailing Address - Fax:
Practice Address - Street 1:15534 RANCH ROAD 620 N STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5277
Practice Address - Country:US
Practice Address - Phone:512-580-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty