| Central Park Pediatric Dentistry | |
|
1005 W 38th St Ste 200 Austin TX 78705-1042 | |
| (512) 330-4624 | |
| Not Available |
| Full Name | Central Park Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1005 W 38th St Ste 200, Austin, Texas |
| Authorized Official Name and Position | Daniel Crandall Johnson (OWNER/DENTIST) |
| Authorized Official Contact | 5123304624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Park Pediatric Dentistry 1005 W 38th St Ste 200 Austin TX 78705-1042 Ph: (512) 330-4624 | Central Park Pediatric Dentistry 1005 W 38th St Ste 200 Austin TX 78705-1042 Ph: (512) 330-4624 |
| NPI Number | 1639597222 |
|---|---|
| Provider Enumeration Date | 04/01/2014 |
| Last Update Date | 10/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639597222 | NPI | - | NPPES |
| 1619250123 | Other | INDIVIDUAL NPI | |
| 3194185-03 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 28784 (Texas) | Primary |
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