Provider Demographics
NPI:1972799484
Name:AUSTIN, PAMELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 ALBATROSS ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2715
Mailing Address - Country:US
Mailing Address - Phone:906-226-6531
Mailing Address - Fax:
Practice Address - Street 1:1960 US HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9131
Practice Address - Country:US
Practice Address - Phone:906-226-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI148731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice