| Seton Oral & Maxillofacial Surgery | |
|
901 W 38th St Suite 410 Austin TX 78705 | |
| (512) 992-1378 | |
| (512) 992-1379 |
| Full Name | Seton Oral & Maxillofacial Surgery |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 901 W 38th St, Austin, Texas |
| Authorized Official Name and Position | Clayton Carsner (VP/COO) |
| Authorized Official Contact | 5123245846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Seton Oral & Maxillofacial Surgery 1345 Philomena St Ste 410.3 Austin TX 78723 Ph: (512) 992-1378 | Seton Oral & Maxillofacial Surgery 901 W 38th St Suite 410 Austin TX 78705 Ph: (512) 992-1378 |
| NPI Number | 1124598917 |
|---|---|
| Provider Enumeration Date | 12/05/2018 |
| Last Update Date | 07/22/2019 |
| Medicare PECOS PAC ID | 7113951377 |
|---|---|
| Medicare Enrollment ID | O20190129001320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124598917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Jodie Roth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053433102 PECOS PAC ID: 1254425127 Enrollment ID: I20070922000163 |
| Provider Name | Harry P Casmedes |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1013084169 PECOS PAC ID: 9739343591 Enrollment ID: I20120611000285 |
| Provider Name | Ann H Kristovich |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1679799431 PECOS PAC ID: 4284942665 Enrollment ID: I20151005001660 |
| Provider Name | Nolan Jenkins |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124456363 PECOS PAC ID: 7214234988 Enrollment ID: I20190131003277 |
| Provider Name | Amy Elizabeth Mcfarling |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255866596 PECOS PAC ID: 9133497985 Enrollment ID: I20230816003114 |
| Provider Name | Luke Tibbitts |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1013448885 PECOS PAC ID: 1355612078 Enrollment ID: I20231115000289 |
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