Organization
J. STEVEN WIDNER, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES STEVEN WIDNER DDS (PRESIDENT)
(512) 452-3223
Entity
Organization
Contact information
Practice address
1500 W 38TH ST, SUITE 51, AUSTIN, TX 78731-6321
(512) 452-3223
Mailing address
1500 W 38TH ST, SUITE 51, AUSTIN, TX 78731-6321
(512) 452-3223
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
15113
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000653489
UNITED CONCORDIA
TX
01
—
00G36G
BLUE CROSS AND BLUE SHIELD
TX
Enumeration date
06/20/2008
Last updated
09/07/2011
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