Provider Demographics
NPI:1497991210
Name:AUSTIN PRIMARY DENTAL INC
Entity Type:Organization
Organization Name:AUSTIN PRIMARY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYASHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:KYATAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-440-1333
Mailing Address - Street 1:6700 W GATE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4867
Mailing Address - Country:US
Mailing Address - Phone:512-440-1333
Mailing Address - Fax:512-440-0484
Practice Address - Street 1:6700 W GATE BLVD
Practice Address - Street 2:STE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4867
Practice Address - Country:US
Practice Address - Phone:512-440-1333
Practice Address - Fax:512-440-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty