Provider Demographics
NPI:1801373782
Name:AUSTIN DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:AUSTIN DENTAL GROUP PLLC
Other - Org Name:04 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-451-8256
Mailing Address - Street 1:1901 BARTON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3217
Mailing Address - Country:US
Mailing Address - Phone:512-640-4090
Mailing Address - Fax:512-386-1142
Practice Address - Street 1:3115 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5803
Practice Address - Country:US
Practice Address - Phone:512-640-4090
Practice Address - Fax:512-386-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty