Provider Demographics
NPI:1720195498
Name:AUSTIN PERIODONTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:AUSTIN PERIODONTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:DOLCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:512-346-6097
Mailing Address - Street 1:7800 N MOPAC
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8961
Mailing Address - Country:US
Mailing Address - Phone:512-346-6097
Mailing Address - Fax:512-346-8135
Practice Address - Street 1:7800 N MOPAC
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-346-6097
Practice Address - Fax:512-346-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76731223P0300X
TX165311223P0300X
TX202561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty