Krista Decoursin, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

36295 Issued in TX

Practice address

3305 Northland Dr Ste 515
Austin, TX 78731-4991

Phone

(512) 452-9296

NPI assigned

Sep 3, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Austin Dental Spa, PLLC

  • General Practice Dentistry
  • Austin, TX
  • NPI 1912474651
  NPD (past)

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1962016253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 BURNET RD APT 2128",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787584594",
            "telephone_number": "920-450-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 NORTHLAND DR STE 515",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787314991",
            "telephone_number": "512-452-9296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECOURSIN",
        "first_name": "KRISTA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "36295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.austindentalspa.com/contact-us/",
            "affiliation": "N",
            "address_1": "3305 Northland Dr Ste 515",
            "city": "Austin",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787314991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dentist in Austin, TX
• Providers in Austin, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.