Healthcare Provider Details

I. General information

NPI: 1134748999
Provider Name (Legal Business Name): AUSTIN THOMAS BER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 CARDINAL DR
THIBODAUX LA
70301-3506
US

IV. Provider business mailing address

511 CARDINAL DR
THIBODAUX LA
70301-3506
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-9379
  • Fax:
Mailing address:
  • Phone: 985-447-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7102
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: