=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689159378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIP SMILES DENTISTRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2018
-----------------------------------------------------
Last Update Date | 09/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1104 SOUTH LINDEN RD BUILDING B, SUITE 1
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-283-6337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 W 42ND ST APT S9C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-532-0270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. CATRISE AUSTIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 646-532-0270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------