Provider Demographics
NPI:1972704559
Name:GREGORY J AUSTRIA DDS XENIA FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:GREGORY J AUSTRIA DDS XENIA FAMILY DENTAL LLC
Other - Org Name:BRILLIANT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOSKUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-376-9975
Mailing Address - Street 1:1289 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1655
Mailing Address - Country:US
Mailing Address - Phone:937-376-9975
Mailing Address - Fax:
Practice Address - Street 1:1289 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1655
Practice Address - Country:US
Practice Address - Phone:937-376-9975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty