Healthcare Provider Details

I. General information

NPI: 1952803827
Provider Name (Legal Business Name): JONATHAN C AUSTIN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S MAGNOLIA ST
LINCOLNTON NC
28092
US

IV. Provider business mailing address

640 S MAGNOLIA ST
LINCOLNTON NC
28092-3736
US

V. Phone/Fax

Practice location:
  • Phone: 704-732-3336
  • Fax: 704-735-3637
Mailing address:
  • Phone: 704-732-3336
  • Fax: 704-735-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8999385
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: DR. JONATHAN AUSTIN
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 704-732-3336