Provider Demographics
NPI:1013178268
Name:J. STEVEN WIDNER, DDS, PC
Entity Type:Organization
Organization Name:J. STEVEN WIDNER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-452-3223
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:SUITE 51
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-452-3223
Mailing Address - Fax:
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:SUITE 51
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-452-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000653489OtherUNITED CONCORDIA
TX00G36GOtherBLUE CROSS AND BLUE SHIELD