Provider Demographics
NPI:1679587133
Name:UPDYKE, JOHN R (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:UPDYKE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 HYMEADOW DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1831
Mailing Address - Country:US
Mailing Address - Phone:512-682-5437
Mailing Address - Fax:512-258-1615
Practice Address - Street 1:12501 HYMEADOW DR STE 1A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1831
Practice Address - Country:US
Practice Address - Phone:512-682-5437
Practice Address - Fax:512-258-1615
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry