Healthcare Provider Details

I. General information

NPI: 1134845167
Provider Name (Legal Business Name): BARRET AUSTIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 3RD ST STE B
EDMOND OK
73034-3822
US

IV. Provider business mailing address

125 E 3RD ST STE B
EDMOND OK
73034-3822
US

V. Phone/Fax

Practice location:
  • Phone: 405-562-5326
  • Fax: 405-562-5226
Mailing address:
  • Phone: 405-562-5326
  • Fax: 405-562-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRET AUSTIN
Title or Position: OWNER
Credential: DDS
Phone: 580-465-0147