Organization
AUSTIN DSG, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PEJMAN KHOSRAVIAN DMD (CEO)
(512) 722-6338
Entity
Organization
Contact information
Practice address
5000 DAVIS LN, SUITE #101, AUSTIN, TX 78749-3683
(512) 441-6200
Mailing address
1920 CORPORATE DR, UNIT #107A, SAN MARCOS, TX 78666-6283
(512) 722-6338
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
25904
TX
1223P0221X
Pediatric Dentistry
25904
TX
Other
Enumeration date
05/11/2016
Last updated
05/11/2016
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