NPI 1063945848 · live from the CMS NPI Registry
Austin Blvd. Family Dentistry, P.C.
Dentist, General Practice in Red Oak, TX. National Provider Identifier 1063945848, active.
NPI record
| NPI | 1063945848 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 101 Austin Blvd., Ste 100, Red Oak, TX 75154 |
| Practice phone | 770-916-5031 |
| Mailing address | 1090 Northchase Pkwy Ste. 150, Marietta, GA 30067 |
| Enumerated | April 7, 2017 |
| Last updated | April 13, 2017 |
| Authorized official | Alan Martin, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | — |
| Dentist, Endodontics | 1223E0200X | — |
| Dentist, Pediatric Dentistry | 1223P0221X | — |
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | — |
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.