Provider Demographics
NPI:1386136810
Name:CANVAS DENTAL PLLC
Entity type:Organization
Organization Name:CANVAS DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:ARISMENDI
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-983-1139
Mailing Address - Street 1:3621 W SLAUGHTER LN APT 134
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8517 FM 1826
Practice Address - Street 2:BLDG 1 ST 500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-646-4505
Practice Address - Fax:512-646-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty