Provider Demographics
NPI:1003030248
Name:AUSTRIA, MARK P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:AUSTRIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6151 WILSON MILLS RD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2128
Mailing Address - Country:US
Mailing Address - Phone:440-446-9040
Mailing Address - Fax:440-473-0517
Practice Address - Street 1:6151 WILSON MILLS RD
Practice Address - Street 2:SUITE #300
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2128
Practice Address - Country:US
Practice Address - Phone:440-446-9040
Practice Address - Fax:440-473-0517
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics