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General NPI Number Information
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NPI Number | 1588087993
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Entity Type | Organization
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Legal Business Name | AUSTIN FAMILY DENTISTY OF LITTLE ROCK
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 11211 CANTRELL RD STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72212-1819
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Country | US
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Telephone | 501-223-9489
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Fax |
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Provider Business Mailing Address
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Address Line | 11211 CANTRELL RD STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72212-1819
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Country | US
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Telephone | 501-223-9489
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN ANTHONY AUSTIN
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Credential | DDS
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Telephone | 501-223-9489
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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 | 3057
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License Number State | AR
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