Provider Demographics
NPI:1013609080
Name:LINGLE, AUSTIN MILTON (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MILTON
Last Name:LINGLE
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 1:1000 RIVER POINT DR APT 512
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5675
Mailing Address - Country:US
Mailing Address - Phone:630-219-8042
Mailing Address - Fax:
Practice Address - Street 1:4144 HARBOR TOWN LN
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5856
Practice Address - Country:US
Practice Address - Phone:630-219-8042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program