Healthcare Provider Details

I. General information

NPI: 1841359726
Provider Name (Legal Business Name): DR. SONYA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 EVERGREEN PKWY
EVERGREEN CO
80439-7922
US

IV. Provider business mailing address

2902 EVERGREEN PKWY
EVERGREEN CO
80439-7922
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3567
  • Fax:
Mailing address:
  • Phone: 303-674-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00206429
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: