|
| |
|
1005 W 38th St Ste 200 Austin TX 78705-1042 | |
| (512) 330-4624 | |
| Not Available |
| Full Name | |
|---|---|
| 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 |
|---|---|
1005 W 38th St Ste 200 Austin TX 78705-1042 Ph: (512) 330-4624 | 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 |
Jared Poplin D.m.d., Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6850 Austin Center Blvd Ste 220, Austin, TX 78731 Phone: 785-691-6171 | |
Ac Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 13616 N Highway 183, Austin, TX 78750 Phone: 512-682-5437 | |