Provider Demographics
NPI:1285937367
Name:NIA ORTHODONTICS PA
Entity type:Organization
Organization Name:NIA ORTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIC
Authorized Official - Prefix:
Authorized Official - First Name:FARSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-583-9679
Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9679
Mailing Address - Fax:512-334-2321
Practice Address - Street 1:5339 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2428
Practice Address - Country:US
Practice Address - Phone:512-583-9679
Practice Address - Fax:512-334-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00261461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty