Provider Demographics
NPI:1558774554
Name:AUSTIN PERIO HEALTH
Entity Type:Organization
Organization Name:AUSTIN PERIO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:CHAPA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-549-7140
Mailing Address - Street 1:8200 N MOPAC EXPY
Mailing Address - Street 2:STE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8849
Mailing Address - Country:US
Mailing Address - Phone:512-346-2490
Mailing Address - Fax:512-346-2347
Practice Address - Street 1:4310 MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3331
Practice Address - Country:US
Practice Address - Phone:512-454-6861
Practice Address - Fax:512-454-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty