Provider Demographics
NPI:1598091415
Name:AUSTIN, KEVIN R (KEVIN R AUSTIN)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:KEVIN R AUSTIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9682
Mailing Address - Country:US
Mailing Address - Phone:417-725-9600
Mailing Address - Fax:417-725-9566
Practice Address - Street 1:708 W MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9682
Practice Address - Country:US
Practice Address - Phone:417-725-9600
Practice Address - Fax:417-725-9566
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020142011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics