Provider Demographics
NPI:1205004090
Name:JOHN AUSTIN, DDS, PLLC
Entity type:Organization
Organization Name:JOHN AUSTIN, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-733-8890
Mailing Address - Street 1:4256 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2908
Mailing Address - Country:US
Mailing Address - Phone:810-733-8890
Mailing Address - Fax:
Practice Address - Street 1:4256 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2908
Practice Address - Country:US
Practice Address - Phone:810-733-8890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901017650OtherSTATE OF MICHIGAN