Provider Demographics
NPI:1508875147
Name:AUSTIN ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:AUSTIN ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ASHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-1220
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-454-1220
Mailing Address - Fax:512-467-0363
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-454-1220
Practice Address - Fax:512-467-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQW81Medicare ID - Type UnspecifiedPROVIDE NUMBER