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General NPI Number Information
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NPI Number | 1649844069
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Entity Type | Individual
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Provider Name | AUSTIN RODENBERG DMD, MSD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 6400 WESTWIND WAY STE C
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City | CRESTWOOD
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State | KY
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Zip | 40014-6773
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Country | US
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Telephone | 502-754-6633
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Fax | 859-207-5102
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Provider Business Mailing Address
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Address Line | 934 WOODLAND RIDGE CIR
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City | LA GRANGE
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State | KY
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Zip | 40031-1373
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Country | US
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Telephone | 270-572-9309
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10612
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10612
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License Number State | KY
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