Provider Demographics
NPI:1255594735
Name:CENTRAL TEXAS ORTHODONTICS, PC
Entity type:Organization
Organization Name:CENTRAL TEXAS ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ST. LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:512-292-1910
Mailing Address - Street 1:3413 SLAUGHTER LN W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5711
Mailing Address - Country:US
Mailing Address - Phone:512-292-1910
Mailing Address - Fax:512-282-9905
Practice Address - Street 1:3413 SLAUGHTER LN W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5711
Practice Address - Country:US
Practice Address - Phone:512-292-1910
Practice Address - Fax:512-282-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23702261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental