| NPI | 1639664246 |
|---|---|
| Doing Business As | SOUTH AUSTIN DENTIST |
| Entity Type | Organization |
| Authorized Contact | CASSANDRA PETERSEN Credentialing Team Lead 217-540-8972 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-06-26 |