Provider Demographics
NPI:1487901237
Name:AUSTIN CENTER FOR ENDODONTICS, PLLC
Entity type:Organization
Organization Name:AUSTIN CENTER FOR ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-879-1350
Mailing Address - Street 1:3301 NORTHLAND DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4939
Mailing Address - Country:US
Mailing Address - Phone:512-879-1350
Mailing Address - Fax:
Practice Address - Street 1:3301 NORTHLAND DR
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4939
Practice Address - Country:US
Practice Address - Phone:512-879-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty