Provider Demographics
NPI:1518313337
Name:AUSTIN DSG, PLLC
Entity Type:Organization
Organization Name:AUSTIN DSG, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSRAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-722-6338
Mailing Address - Street 1:1920 CORPORATE DR
Mailing Address - Street 2:UNIT #107A
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6283
Mailing Address - Country:US
Mailing Address - Phone:512-722-6338
Mailing Address - Fax:
Practice Address - Street 1:5000 DAVIS LN
Practice Address - Street 2:SUITE #101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3683
Practice Address - Country:US
Practice Address - Phone:512-441-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX259041223E0200X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty