Provider Demographics
NPI:1033509575
Name:AUSTIN BABCOCK LLC
Entity Type:Organization
Organization Name:AUSTIN BABCOCK LLC
Other - Org Name:SEDONA DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-282-1514
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:928-282-4428
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:928-282-1514
Practice Address - Fax:928-282-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty