Provider Demographics
NPI:1245827096
Name:AUSTIN PERIODONTICS PA
Entity type:Organization
Organization Name:AUSTIN PERIODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:512-589-9108
Mailing Address - Street 1:8200 N MOPAC EXPY STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8845
Mailing Address - Country:US
Mailing Address - Phone:512-863-9500
Mailing Address - Fax:512-863-9562
Practice Address - Street 1:8200 N MOPAC EXPY STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8845
Practice Address - Country:US
Practice Address - Phone:512-863-9500
Practice Address - Fax:512-863-9562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty