Provider Demographics
NPI:1538507181
Name:THE AUSTIN DENTIST, PLLC
Entity Type:Organization
Organization Name:THE AUSTIN DENTIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. HORNE
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-467-4722
Mailing Address - Street 1:5701 W SLAUGHTER LN
Mailing Address - Street 2:SUITE B120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-6527
Mailing Address - Country:US
Mailing Address - Phone:512-467-4722
Mailing Address - Fax:512-467-4768
Practice Address - Street 1:5701 W SLAUGHTER LN
Practice Address - Street 2:SUITE B120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-6527
Practice Address - Country:US
Practice Address - Phone:512-467-4722
Practice Address - Fax:512-467-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21136122300000X
TX24632122300000X
TX16782124Q00000X
TX16813124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty