Provider Demographics
NPI:1578648515
Name:MODERN FAMILY DENTISTRY OF OAK HILL, P.A.
Entity Type:Organization
Organization Name:MODERN FAMILY DENTISTRY OF OAK HILL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGNOLIA
Authorized Official - Middle Name:MAGGIE
Authorized Official - Last Name:SHARFAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-301-9002
Mailing Address - Street 1:6001 W WILLIAM CANNON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1968
Mailing Address - Country:US
Mailing Address - Phone:512-301-9002
Mailing Address - Fax:512-301-9019
Practice Address - Street 1:6001 W WILLIAM CANNON DR
Practice Address - Street 2:STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1968
Practice Address - Country:US
Practice Address - Phone:512-301-9002
Practice Address - Fax:512-301-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty