Active NPI
Brian Kistenmacher, DDS
- Dentist
- Round Rock, TX
National Provider Identifier
1295854131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17934
- Practice address
- 893 North Interstate Highway 35
Suite 200
Round Rock, TX 78664 - Phone
- (512) 310-9374
- Fax
- (512) 244-3954
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17934 | TX | Primary |
Addresses
Primary practice location
893 North Interstate Highway 35
Suite 200
Round Rock, TX 78664
Mailing address
11615 Angus Rd
Suite 210
Austin, TX 78759-4078
Phone (512) 795-9643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17934 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rose Dental Group PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Austin, TX
- NPI 1366500803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295854131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11615 ANGUS RD",
"address_2": "SUITE 210",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787594078",
"telephone_number": "512-795-9643",
"fax_number": "512-795-9959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "893 NORTH INTERSTATE HIGHWAY 35",
"address_2": "SUITE 200",
"city": "ROUND ROCK",
"state": "TX",
"postal_code": "78664",
"telephone_number": "512-310-9374",
"fax_number": "512-244-3954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISTENMACHER",
"first_name": "BRIAN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "17934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Rock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.