Provider Demographics
NPI:1093376725
Name:CALAWAY, AUSTIN (DMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:CALAWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21155 N 56TH ST APT 3141
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5557
Mailing Address - Country:US
Mailing Address - Phone:509-942-9219
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:520-494-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist