Provider Demographics
NPI:1013358985
Name:IVEY, AUSTIN YEAGER (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:YEAGER
Last Name:IVEY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 E ARAPAHOE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4047
Mailing Address - Country:US
Mailing Address - Phone:303-493-1933
Mailing Address - Fax:303-493-1934
Practice Address - Street 1:14000 E ARAPAHOE RD STE 320
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4047
Practice Address - Country:US
Practice Address - Phone:303-493-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002039551223S0112X
TX293101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty