# AUSTIN COSMETIC SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437664067
- **Authorized official:** TERESA RIDENHOUR (COO)
- **Authorized official phone:** (512) 688-8000

## Contact information

- **Practice address:** 3102 RR 620 S, LAKEWAY, TX 78734
- **Practice address phone:** (512) 688-8000
- **Practice address fax:** (512) 688-8000
- **Mailing address:** 12308 EMORY OAK LN, AUSTIN, TX 78738-5602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | NULL | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 12/05/2017
- **Last updated:** 12/05/2017