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12314 N Interstate 35 Ste 110 Austin TX 78753-1349 | |
| (347) 631-0848 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12314 N Interstate 35 Ste 110, Austin, Texas |
| Authorized Official Name and Position | Suman Kishore Kondragunta (MANAGING MEMBER) |
| Authorized Official Contact | 3476310848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15412 Cabrillo Way Austin TX 78738-4128 Ph: (347) 631-0848 | 12314 N Interstate 35 Ste 110 Austin TX 78753-1349 Ph: (347) 631-0848 |
| NPI Number | 1073391728 |
|---|---|
| Provider Enumeration Date | 09/14/2023 |
| Last Update Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073391728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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 | |