Provider Demographics
NPI:1821127937
Name:MEARES, AUSTIN B (DMD, PA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:B
Last Name:MEARES
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2320
Mailing Address - Country:US
Mailing Address - Phone:803-748-8797
Mailing Address - Fax:803-748-8799
Practice Address - Street 1:529 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2320
Practice Address - Country:US
Practice Address - Phone:803-748-8797
Practice Address - Fax:803-748-8799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice