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General NPI Number Information
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NPI Number | 1255415956
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Entity Type | Organization
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Legal Business Name | AUSTIN FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 3201 CLUB MANOR SUITE A
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City | MAUMELLE
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State | AR
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Zip | 72113
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Country | US
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Telephone | 501-851-3262
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Fax | 501-851-3766
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Provider Business Mailing Address
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Address Line | 3201 CLUB MANOR SUITE A
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City | MAUMELLE
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State | AR
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Zip | 72113
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Country | US
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Telephone | 501-851-3262
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Fax | 501-851-3766
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Authorized Official
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Title or Position | OWNER PRES
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Name | DR. BRYAN A AUSTIN
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Credential | DDS
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Telephone | 501-851-3262
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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 | AR3057
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | AR3521
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License Number State | AR
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