Provider Demographics
NPI:1174762967
Name:AUSTIN CONE BEAM IMAGING
Entity type:Organization
Organization Name:AUSTIN CONE BEAM IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E.
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-328-1985
Mailing Address - Street 1:3305 NORTHLAND DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4961
Mailing Address - Country:US
Mailing Address - Phone:512-458-2224
Mailing Address - Fax:
Practice Address - Street 1:3305 NORTHLAND DR
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4961
Practice Address - Country:US
Practice Address - Phone:512-458-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR31533292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory