Provider Demographics
NPI:1215280557
Name:NORTH AUSTIN PEDIATRIC DENTAL, PLLC
Entity type:Organization
Organization Name:NORTH AUSTIN PEDIATRIC DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-574-6923
Mailing Address - Street 1:8716 RESEARCH BLVD # 125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6420
Mailing Address - Country:US
Mailing Address - Phone:512-454-4646
Mailing Address - Fax:512-419-0561
Practice Address - Street 1:8716 RESEARCH BLVD # 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6420
Practice Address - Country:US
Practice Address - Phone:512-454-4646
Practice Address - Fax:512-419-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty