Provider Demographics
NPI:1578601407
Name:AUSTRIA, GREGORY J (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:AUSTRIA
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 1:432 KINSEY RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1413
Mailing Address - Country:US
Mailing Address - Phone:937-376-9975
Mailing Address - Fax:
Practice Address - Street 1:1289 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1655
Practice Address - Country:US
Practice Address - Phone:937-376-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice