Provider Demographics
NPI:1184354466
Name:STILES, AUSTIN RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:RICHARD
Last Name:STILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6860
Mailing Address - Country:US
Mailing Address - Phone:334-510-3990
Mailing Address - Fax:334-510-3991
Practice Address - Street 1:2542 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6860
Practice Address - Country:US
Practice Address - Phone:334-510-3990
Practice Address - Fax:334-510-3991
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007053-C11223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL285948Medicaid