Provider Demographics
NPI:1881029049
Name:AUS DENTAL ASSOC 2,PLLC
Entity Type:Organization
Organization Name:AUS DENTAL ASSOC 2,PLLC
Other - Org Name:PLAZA DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-400-0244
Mailing Address - Street 1:14900 AVERY RANCH BLVD
Mailing Address - Street 2:C-100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3951
Mailing Address - Country:US
Mailing Address - Phone:512-238-1244
Mailing Address - Fax:
Practice Address - Street 1:14900 AVERY RANCH BLVD
Practice Address - Street 2:C-100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-3951
Practice Address - Country:US
Practice Address - Phone:512-238-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty