Provider Demographics
NPI:1720132905
Name:AUSTIN ORTHODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:AUSTIN ORTHODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:512-447-5194
Mailing Address - Street 1:6425 SOUTH IH-35
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4230
Mailing Address - Country:US
Mailing Address - Phone:512-447-5194
Mailing Address - Fax:512-447-7848
Practice Address - Street 1:6425 SOUTH IH-35
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4230
Practice Address - Country:US
Practice Address - Phone:512-447-5194
Practice Address - Fax:512-447-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty