Provider Demographics
NPI:1639466022
Name:VANDUSEN, AUSTIN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:SCOTT
Last Name:VANDUSEN
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 1:800 WEATHERLY DR
Mailing Address - Street 2:103-B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8957
Mailing Address - Country:US
Mailing Address - Phone:931-647-8437
Mailing Address - Fax:931-647-8439
Practice Address - Street 1:800 WEATHERLY DR
Practice Address - Street 2:103-B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8957
Practice Address - Country:US
Practice Address - Phone:931-647-8437
Practice Address - Fax:931-647-8439
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist