Duchess Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DUCHESS DENTAL PLLC

Practice address

4301 W William Cannon Dr
Suite B240
Austin, TX 78749-1473

Phone

(512) 892-7800

Fax

(512) 892-7802

NPI assigned

Nov 9, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jack Fan, DDS

Title

Owner

Phone

(347) 688-9827

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1821530635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 W WILLIAM CANNON DR",
            "address_2": "SUITE B240",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787491473",
            "telephone_number": "512-892-7800",
            "fax_number": "512-892-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W WILLIAM CANNON DR",
            "address_2": "SUITE B240",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787491473",
            "telephone_number": "512-892-7800",
            "fax_number": "512-892-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUCHESS DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-688-9827",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Marie Dubose, NP
• Melissa Dubose
• Jennifer Duc
• Anne Ducharme-Jones, LCSW
• Sophia Ducharme
• Danielle A Duchnick, LMSW
• Anissa Janay Duck
• Kristi Rebeca Duck
• Claire L Ducker, MA CCC SLP
• Simone Christine Ducloux, M.A., LPC

• General Practice Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.