=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710300314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARONVILLE FAMILY DENTAL - GREGORY J AUSTRIA DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2014
-----------------------------------------------------
Last Update Date | 02/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11440 LIPPELMAN RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-771-9190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11440 LIPPELMAN RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-771-9190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREGORY AUSTRIA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 937-376-9975
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 18186
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------