Tx Southern Dental Ppo PC

NPI #1043080500 in Austin, Texas

Provider Information

NPI Number: 1043080500
Entity Type: Organization
Organization Name: Tx Southern Dental Ppo PC
Subpart: Yes (part of a larger organization)
Parent Organization: TX SOUTHERN DENTAL PPO PC
Primary Specialty: Dentist
Enumeration Date: Jan 5, 2024
Last Updated: Apr 10, 2024

Practice Location

Address: 6012 W WILLIAM CANNON DR STE A103
City: Austin
State: Texas
ZIP Code: 78749-1976
Phone: (512) 288-3930

Authorized Official

Name: CHRISTINE NELSON
Title: VP, REVENUE CYCLE
Phone: (469) 596-6137

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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