Provider Demographics
NPI:1083751747
Name:AUSTIN, CARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:M
Last Name:AUSTIN
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 1:165 INDIAN LAKE BLVD.
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6204
Mailing Address - Country:US
Mailing Address - Phone:615-824-4364
Mailing Address - Fax:615-826-4364
Practice Address - Street 1:165 INDIAN LAKE BLVD.
Practice Address - Street 2:SUITE 112
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6204
Practice Address - Country:US
Practice Address - Phone:615-824-4364
Practice Address - Fax:615-826-4364
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist