Provider Demographics
NPI:1659860112
Name:SW AUSTIN DENTAL PLLC
Entity Type:Organization
Organization Name:SW AUSTIN DENTAL PLLC
Other - Org Name:SOUTHWEST AUSTIN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOUMBOUKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-520-1473
Mailing Address - Street 1:6000 W WILLIAM CANNON DR STE A200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1977
Mailing Address - Country:US
Mailing Address - Phone:512-282-0277
Mailing Address - Fax:512-282-7207
Practice Address - Street 1:6000 W WILLIAM CANNON DR STE A200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1977
Practice Address - Country:US
Practice Address - Phone:512-282-0277
Practice Address - Fax:512-282-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty