Provider Demographics
NPI:1922319169
Name:NUNEZ, AUSTIN GUSTAVO (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:GUSTAVO
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2914
Mailing Address - Country:US
Mailing Address - Phone:707-658-2320
Mailing Address - Fax:
Practice Address - Street 1:301 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2914
Practice Address - Country:US
Practice Address - Phone:707-658-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25568122300000X
CA1002771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist