Provider Demographics
NPI:1043712888
Name:AUSTIN VETTER, DDS, LLC
Entity Type:Organization
Organization Name:AUSTIN VETTER, DDS, LLC
Other - Org Name:VETTER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-240-3573
Mailing Address - Street 1:1331 32ND AVE S STE 3
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5989
Mailing Address - Country:US
Mailing Address - Phone:701-235-7322
Mailing Address - Fax:
Practice Address - Street 1:1331 32ND AVE S STE 3
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5989
Practice Address - Country:US
Practice Address - Phone:701-235-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2327261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental