Provider Demographics
NPI:1003836354
Name:BABCOCK, AUSTIN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BRUCE
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W STATE ROUTE 89A STE D1
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3578
Mailing Address - Country:US
Mailing Address - Phone:928-282-1514
Mailing Address - Fax:
Practice Address - Street 1:1120 W STATE ROUTE 89A STE D1
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3578
Practice Address - Country:US
Practice Address - Phone:929-282-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-91731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice