MEDICARE: DR. SOPHIE DUVAL-AUSTIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	8183	KY
2	1223G0001X	General Practice Dentistry	8183	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316094329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIE DUVAL-AUSTIN DMD

Provider Business Mailing Address
First Line	:	25 TOWN CENTER BLVD
Second Line	:	SUITE 202
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-2417
Country	:	US
Telephone Number	:	859-344-6200
Fax Number	:	859-344-0980

Provider Business Practice Location Address
First Line	:	25 TOWN CENTER BLVD
Second Line	:	SUITE 202
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-2417
Country	:	US
Telephone Number	:	859-344-6200
Fax Number	:	859-344-0980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/29/2013

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