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Organization
AUSTIN COSMETIC SURGERY
Active
Organization
AUSTIN COSMETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA RIDENHOUR (COO)
(512) 688-8000
Entity
Organization
Contact information
Practice address
3102 RR 620 S, LAKEWAY, TX 78734
(512) 688-8000
(512) 688-8000
Mailing address
12308 EMORY OAK LN, AUSTIN, TX 78738-5602
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
NULL
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
12/05/2017
Last updated
12/05/2017
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