NPIMap

Organization Active NPI

North Austin Pediatric Dental, PLLC

  • Pediatric Dentistry
  • Austin, TX
National Provider Identifier
1215280557
Registry record updated Oct 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
24217 Issued in TX
Legal business name
NORTH AUSTIN PEDIATRIC DENTAL, PLLC
Practice address
8716 Research Blvd # 125
Austin, TX 78758-6420
Phone
(512) 454-4646
Fax
(512) 419-0561
NPI assigned
Oct 24, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marty Montgomery, DMD
Title
President
Phone
(512) 574-6923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 24217 TX Primary

Addresses

Primary practice location

8716 Research Blvd # 125
Austin, TX 78758-6420

Mailing address

8716 Research Blvd # 125
Austin, TX 78758-6420
Phone (512) 454-4646

Other names 1

  • Lone Star Pediatric Dental Doing business as

National Provider Directory

National Provider Directory

Locations

8716 Research Blvd
Ste 125
Austin, TX 78758
Phone (512) 454-4646

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1215280557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8716 RESEARCH BLVD # 125",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787586420",
            "telephone_number": "512-454-4646",
            "fax_number": "512-419-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8716 RESEARCH BLVD # 125",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787586420",
            "telephone_number": "512-454-4646",
            "fax_number": "512-419-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH AUSTIN PEDIATRIC DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-574-6923",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "24217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lone Star Pediatric Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.