Basic Information
| Provider Information | |||||||||
| NPI: | 1538507181 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE AUSTIN DENTIST, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 W SLAUGHTER LN | ||||||||
| Address2: | SUITE B120 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787496527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124674722 | ||||||||
| FaxNumber: | 5124674768 | ||||||||
| Practice Location | |||||||||
| Address1: | 5701 W SLAUGHTER LN | ||||||||
| Address2: | SUITE B120 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787496527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124674722 | ||||||||
| FaxNumber: | 5124674768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 06/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | HORNE | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DR. HORNE | ||||||||
| AuthorizedOfficialTelephone: | 5124674722 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 24632 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 124Q00000X | 16782 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dental Hygienist | 124Q00000X | 16813 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dental Hygienist | 122300000X | 21136 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.