Provider Demographics
NPI:1952507238
Name:AUSTIN, RUSSELL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:AUSTIN
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 1:1532 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:FL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-233-0600
Mailing Address - Fax:773-233-0689
Practice Address - Street 1:1532 W 99TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:FL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-233-0600
Practice Address - Fax:773-233-0689
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist