Provider Demographics
NPI:1023374824
Name:AUSTIN/PRAY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:AUSTIN/PRAY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-226-4411
Mailing Address - Street 1:218A E SHOCKLEY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-3739
Mailing Address - Country:US
Mailing Address - Phone:864-226-4411
Mailing Address - Fax:864-226-9323
Practice Address - Street 1:218A E SHOCKLEY FERRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-3739
Practice Address - Country:US
Practice Address - Phone:864-226-4411
Practice Address - Fax:864-226-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26971223G0001X
SC45601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty