Provider Demographics
NPI:1740611706
Name:MARK C. AUSTIN OMFS, PLLC
Entity Type:Organization
Organization Name:MARK C. AUSTIN OMFS, PLLC
Other - Org Name:AUSTIN ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-231-3134
Mailing Address - Street 1:2001 SOUTH BAXTER DR.
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451
Mailing Address - Country:US
Mailing Address - Phone:910-769-1605
Mailing Address - Fax:910-769-1209
Practice Address - Street 1:2001 SOUTH BAXTER DRIVE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-769-1605
Practice Address - Fax:910-769-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7348204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty