Healthcare Provider Details

I. General information

NPI: 1538574009
Provider Name (Legal Business Name): AUSTIN BE DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32316 FIVE MILE RD
LIVONIA MI
48154-6109
US

IV. Provider business mailing address

2425 E 12 MILE RD STE A
WARREN MI
48092-5667
US

V. Phone/Fax

Practice location:
  • Phone: 734-523-8300
  • Fax:
Mailing address:
  • Phone: 586-737-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901600842
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDL12217
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: