Provider Demographics
NPI:1619220811
Name:MICHAEL ALLEN CIAVERELLI, DDS, P.A.
Entity Type:Organization
Organization Name:MICHAEL ALLEN CIAVERELLI, DDS, P.A.
Other - Org Name:BRODIE OAKS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAVERELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-445-5866
Mailing Address - Street 1:4029 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7927
Mailing Address - Country:US
Mailing Address - Phone:512-445-5866
Mailing Address - Fax:512-445-4262
Practice Address - Street 1:4029 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7927
Practice Address - Country:US
Practice Address - Phone:512-445-5866
Practice Address - Fax:512-445-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental