Provider Demographics
NPI:1417483504
Name:AUSTIN L MAUTNER DMD PA
Entity Type:Organization
Organization Name:AUSTIN L MAUTNER DMD PA
Other - Org Name:RIVERBEND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-701-9700
Mailing Address - Street 1:10088 INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-4738
Mailing Address - Country:US
Mailing Address - Phone:561-701-9700
Mailing Address - Fax:
Practice Address - Street 1:10088 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33478
Practice Address - Country:US
Practice Address - Phone:561-701-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19002261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental