Provider Demographics
NPI:1104370667
Name:ABELLANA, AUSTIN G (DMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:G
Last Name:ABELLANA
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 1:721 SHEFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3337
Mailing Address - Country:US
Mailing Address - Phone:864-419-0249
Mailing Address - Fax:
Practice Address - Street 1:601 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1953
Practice Address - Country:US
Practice Address - Phone:864-476-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist