Provider Demographics
NPI:1821783499
Name:AUSTIN T EDDY DMD PLLC
Entity Type:Organization
Organization Name:AUSTIN T EDDY DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-590-1795
Mailing Address - Street 1:4708 LOMA BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-4123
Mailing Address - Country:US
Mailing Address - Phone:435-590-1795
Mailing Address - Fax:
Practice Address - Street 1:115 N BEECH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3207
Practice Address - Country:US
Practice Address - Phone:970-565-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty