Organization
SOUTH AUSTIN MICROENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN ODEGARD (OPERATIONS MANAGER)
(512) 580-9973
Entity
Organization
Contact information
Practice address
2500 W WILLIAM CANNON DR STE 605, AUSTIN, TX 78745-5320
(512) 442-1555
Mailing address
2500 W WILLIAM CANNON DR STE 605, AUSTIN, TX 78745-5320
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093294852
NPI
TX
01
—
1205861473
NPI
TX
01
—
1588863054
NPI
TX
01
—
1740293752
NPI
TX
Enumeration date
11/26/2018
Last updated
11/26/2018
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