Provider Demographics
NPI:1962833996
Name:METRO PERIODONTICS
Entity Type:Organization
Organization Name:METRO PERIODONTICS
Other - Org Name:LONESTAR PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BINGAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-453-1600
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:STE G5
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-453-1600
Mailing Address - Fax:512-453-1503
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:STE G5
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-453-1600
Practice Address - Fax:512-453-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty