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General NPI Number Information
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NPI Number | 1609096106
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Entity Type | Organization
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Legal Business Name | GORDON T. AUSTIN, D.M.D., P.C.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 819 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-4415
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Country | US
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Telephone | 770-832-7374
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Fax | 770-832-7260
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Provider Business Mailing Address
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Address Line | 819 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-4415
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Country | US
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Telephone | 770-832-7374
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Fax | 770-832-7260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON T. AUSTIN
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Credential | DMD
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Telephone | 770-832-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8598
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License Number State | GA
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