Provider Demographics
NPI:1760500078
Name:AIDS SERVICES OF AUSTIN INC
Entity Type:Organization
Organization Name:AIDS SERVICES OF AUSTIN INC
Other - Org Name:JACK SANSING DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF DENTAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-900-3471
Mailing Address - Street 1:PO BOX 4874
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765
Mailing Address - Country:US
Mailing Address - Phone:512-458-2437
Mailing Address - Fax:512-452-3299
Practice Address - Street 1:711 W. 38TH ST.
Practice Address - Street 2:SUITE E-4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-479-6633
Practice Address - Fax:512-479-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental