Provider Demographics
NPI:1609212323
Name:DAVID G AUSTIN DDS INC
Entity Type:Organization
Organization Name:DAVID G AUSTIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-3600
Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-451-3600
Mailing Address - Fax:614-451-3726
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-451-3600
Practice Address - Fax:614-451-3726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID G AUSTIN DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016555332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0436568Medicaid
OH6662470001OtherMEDICARE DME PTAN
OH0436568Medicaid