Provider Demographics
NPI:1891205290
Name:QUINTESSENCE PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:QUINTESSENCE PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AISAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-777-2969
Mailing Address - Street 1:6611 RIVER PLACE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1167
Mailing Address - Country:US
Mailing Address - Phone:512-777-2969
Mailing Address - Fax:512-777-0861
Practice Address - Street 1:6611 RIVER PLACE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1167
Practice Address - Country:US
Practice Address - Phone:512-777-2969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty