=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134845167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRET AUSTIN, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2022
-----------------------------------------------------
Last Update Date | 10/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 E 3RD ST STE B
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-562-5326
-----------------------------------------------------
Fax | 405-562-5226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 E 3RD ST STE B
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-562-5326
-----------------------------------------------------
Fax | 405-562-5226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BARRET AUSTIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 580-465-0147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------