Provider Demographics
NPI:1578805446
Name:AUSTIN SIXTH STREET SMILES
Entity Type:Organization
Organization Name:AUSTIN SIXTH STREET SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-516-1247
Mailing Address - Street 1:1717 W 6TH ST
Mailing Address - Street 2:SUITE 365
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4773
Mailing Address - Country:US
Mailing Address - Phone:512-516-1247
Mailing Address - Fax:512-351-8098
Practice Address - Street 1:1717 W 6TH ST
Practice Address - Street 2:SUITE 365
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4773
Practice Address - Country:US
Practice Address - Phone:512-516-1247
Practice Address - Fax:512-351-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty