Provider Demographics
NPI:1891305173
Name:ENAMEL DENTISTRY DOMAIN PLLC
Entity Type:Organization
Organization Name:ENAMEL DENTISTRY DOMAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HARDIK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODAVADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-988-6484
Mailing Address - Street 1:11005 BURNET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11005 BURNET RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4440
Practice Address - Country:US
Practice Address - Phone:512-646-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental