Provider Demographics
NPI:1255521837
Name:SALUTE ORAL AND FACIAL SURGERY, PA
Entity type:Organization
Organization Name:SALUTE ORAL AND FACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MARCANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-372-6230
Mailing Address - Street 1:10801 N. MOPAC
Mailing Address - Street 2:BLDG. 2 STE. 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:512-372-6230
Mailing Address - Fax:
Practice Address - Street 1:10801 N MOPAC EXPY
Practice Address - Street 2:BLDG. 2 STE. 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5459
Practice Address - Country:US
Practice Address - Phone:512-372-6230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB18386OtherCHIP