Provider Demographics
NPI:1336306869
Name:AUSTIN, BRYAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:A
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 1:3201 CLUB MANOR DR STE A
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6082
Mailing Address - Country:US
Mailing Address - Phone:501-851-3262
Mailing Address - Fax:501-851-3766
Practice Address - Street 1:3201 CLUB MANOR DR STE A
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6082
Practice Address - Country:US
Practice Address - Phone:501-851-3262
Practice Address - Fax:501-851-3766
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR30571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR828326OtherUCCI
AR58662OtherBCBS