Healthcare Provider Details

I. General information

NPI: 1922749076
Provider Name (Legal Business Name): SAMUEL AUSTIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

875 UNION AVE STE C211
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12737
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: