Provider Demographics
NPI:1467551887
Name:AUST, MICHAELANGELO D (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAELANGELO
Middle Name:D
Last Name:AUST
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 1:410 VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4513
Mailing Address - Country:US
Mailing Address - Phone:630-323-9550
Mailing Address - Fax:262-484-4367
Practice Address - Street 1:410 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-4513
Practice Address - Country:US
Practice Address - Phone:630-323-9550
Practice Address - Fax:262-484-4367
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6002-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33799600Medicaid