Provider Demographics
NPI:1972171932
Name:KIDS TOOTH TEAM SOUTH AUSTIN PLLC
Entity Type:Organization
Organization Name:KIDS TOOTH TEAM SOUTH AUSTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-293-0387
Mailing Address - Street 1:1245 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2269
Mailing Address - Country:US
Mailing Address - Phone:512-523-4774
Mailing Address - Fax:512-355-7030
Practice Address - Street 1:1217 W SLAUGHTER LN STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6916
Practice Address - Country:US
Practice Address - Phone:512-523-4774
Practice Address - Fax:512-355-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty