Provider Demographics
NPI:1598401598
Name:AUSTIN DENTAL WESTLAKE PLLC
Entity Type:Organization
Organization Name:AUSTIN DENTAL WESTLAKE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-731-3895
Mailing Address - Street 1:8825 BEE CAVES RD STE E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4720
Mailing Address - Country:US
Mailing Address - Phone:512-263-8332
Mailing Address - Fax:
Practice Address - Street 1:8825 FM 2244 RD STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4720
Practice Address - Country:US
Practice Address - Phone:512-263-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780318337OtherINDIVIDUAL
TX1528282407OtherINDIVIDUAL
TX1427273382OtherINDIVIDUAL