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General NPI Number Information
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NPI Number | 1326737594
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Entity Type | Individual
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Provider Name | AUSTIN THOMAS DAVIES DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 06/30/2024
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Provider Practice Location Address
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Address Line | 225 GUNDERSON DR
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City | PORTAGE
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State | WI
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Zip | 53901-3430
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Country | US
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Telephone | 608-742-3272
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Fax |
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Provider Business Mailing Address
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Address Line | W5566 GEMA DR
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City | PARDEEVILLE
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State | WI
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Zip | 53954-9795
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Country | US
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Telephone | 608-617-5255
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6001337
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7961
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License Number State | NE
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