NPIMap

Organization Active NPI

Herzog Austin Domain PC

  • Dentist
  • Austin, TX
National Provider Identifier
1609209105
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HERZOG AUSTIN DOMAIN PC
Practice address
3310 W. Braker LN BLD. 1 #100
Austin, TX 78758
Phone
(512) 617-0110
Fax
(512) 617-0111
NPI assigned
Aug 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Authorized official

Name
Cortney Black
Title
Manager
Phone
(512) 617-0110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X TX Primary

Addresses

Primary practice location

3310 W. Braker LN BLD. 1 #100
Austin, TX 78758

Mailing address

3310 W. Braker LN BLD. 1 #100
Austin, TX 78758
Phone (512) 617-0110

Other names 1

  • FLOSS Doing business as

National Provider Directory

National Provider Directory

Locations

3310 W Braker Ln
Bldg 1-100
Austin, TX 78758
Phone (512) 617-0110

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376956800000",
    "number": "1609209105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 W. BRAKER LN BLD. 1 #100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78758",
            "telephone_number": "512-617-0110",
            "fax_number": "512-617-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 W. BRAKER LN BLD. 1 #100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78758",
            "telephone_number": "512-617-0110",
            "fax_number": "512-617-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERZOG AUSTIN DOMAIN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2013-08-20",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CORTNEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "512-617-0110"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FLOSS",
            "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 Aug 20, 2013; 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.