Provider Demographics
NPI:1669118345
Name:EMERGENCY DENTIST OF AUSTIN, PLLC
Entity type:Organization
Organization Name:EMERGENCY DENTIST OF AUSTIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-200-4949
Mailing Address - Street 1:3414 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2606
Mailing Address - Country:US
Mailing Address - Phone:512-200-4949
Mailing Address - Fax:
Practice Address - Street 1:1030 NORWOOD PARK BLVD STE 324
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6609
Practice Address - Country:US
Practice Address - Phone:512-588-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental