MEDICARE: DR. BRUCE W AUSTIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D6255	OR
2	1223G0001X	General Practice Dentistry	D6255	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932133303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE W AUSTIN DMD

Provider Business Mailing Address
First Line	:	1776 SW MADISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1715
Country	:	US
Telephone Number	:	503-224-1044
Fax Number	:	503-621-2235

Provider Business Practice Location Address
First Line	:	12750 SE STARK ST BLDG E
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97233-1539
Country	:	US
Telephone Number	:	971-347-3009
Fax Number	:	971-256-3277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/14/2024

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