Organization
AUSTIN CENTRAL PARK PEDIATRIC DENTISTRY
Active
Other names
Central Park Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL CRANDALL JOHNSON DDS (OWNER/DENTIST)
(512) 330-4624
Entity
Organization
Contact information
Practice address
1005 W 38TH ST STE 200, AUSTIN, TX 78705-1042
(512) 330-4624
Mailing address
1005 W 38TH ST STE 200, AUSTIN, TX 78705-1042
(512) 330-4624
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
28784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619250123
INDIVIDUAL NPI
—
05
—
3194185-03
—
TX
Enumeration date
04/01/2014
Last updated
10/21/2024
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