# SOUTH AUSTIN MICROENDODONTICS

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

## Provider details

- **NPI number:** 1457821126
- **Authorized official:** MEGAN ODEGARD (OPERATIONS MANAGER)
- **Authorized official phone:** (512) 580-9973

## Contact information

- **Practice address:** 2500 W WILLIAM CANNON DR STE 605, AUSTIN, TX 78745-5320
- **Practice address phone:** (512) 442-1555
- **Mailing address:** 2500 W WILLIAM CANNON DR STE 605, AUSTIN, TX 78745-5320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2018
- **Last updated:** 11/26/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1093294852 | NPI | TX |
| 01 | — | 1205861473 | NPI | TX |
| 01 | — | 1588863054 | NPI | TX |
| 01 | — | 1740293752 | NPI | TX |