Provider Demographics
NPI:1003166281
Name:AUSTIN C. POWELL, D.M.D., LLC
Entity Type:Organization
Organization Name:AUSTIN C. POWELL, D.M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-538-3335
Mailing Address - Street 1:1626 29TH CT S
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2442
Mailing Address - Country:US
Mailing Address - Phone:205-538-3335
Mailing Address - Fax:
Practice Address - Street 1:1626 29TH CT S
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2442
Practice Address - Country:US
Practice Address - Phone:205-538-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty