MEDICARE: DR. RUSSELL J AUSTIN DDS

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		IL

General Provider Information

NPI Number	:	1952507238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL J AUSTIN DDS

Provider Business Mailing Address
First Line	:	1532 W 99TH ST
Second Line	:
City	:	CHICAGO
State	:	FL
Zip	:	60643
Country	:	US
Telephone Number	:	773-233-0600
Fax Number	:	773-233-0689

Provider Business Practice Location Address
First Line	:	1532 W 99TH ST
Second Line	:
City	:	CHICAGO
State	:	FL
Zip	:	60643
Country	:	US
Telephone Number	:	773-233-0600
Fax Number	:	773-233-0689

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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