Provider Demographics
NPI:1891015830
Name:MAUTNER, AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:MAUTNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N PALM AVE
Mailing Address - Street 2:STE #104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3200
Mailing Address - Country:US
Mailing Address - Phone:954-435-5020
Mailing Address - Fax:954-435-1261
Practice Address - Street 1:1601 N PALM AVE
Practice Address - Street 2:STE #104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3200
Practice Address - Country:US
Practice Address - Phone:954-435-5020
Practice Address - Fax:954-435-1261
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist