Provider Demographics
NPI:1821315227
Name:AUSTIN FAMILY DENTISTRY PPLC
Entity Type:Organization
Organization Name:AUSTIN FAMILY DENTISTRY PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-620-1411
Mailing Address - Street 1:4631 AIRPORT BLVD
Mailing Address - Street 2:120A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3453
Mailing Address - Country:US
Mailing Address - Phone:818-620-1411
Mailing Address - Fax:512-402-9986
Practice Address - Street 1:4631 AIRPORT BLVD
Practice Address - Street 2:120A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3453
Practice Address - Country:US
Practice Address - Phone:818-620-1411
Practice Address - Fax:512-402-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty