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General NPI Number Information
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NPI Number | 1093376725
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Entity Type | Individual
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Provider Name | AUSTIN CALAWAY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 21300 N JOHN WAYNE PKWY STE 108
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City | MARICOPA
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State | AZ
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Zip | 85139-8964
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Country | US
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Telephone | 520-494-7578
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Fax |
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Provider Business Mailing Address
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Address Line | 21155 N 56TH ST APT 3141
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City | PHOENIX
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State | AZ
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Zip | 85054-5557
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Country | US
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Telephone | 509-942-9219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D010408
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License Number State | AZ
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