Provider Demographics
NPI:1639344757
Name:JEFFREY P. AUSTIN, D.D.S., PC
Entity type:Organization
Organization Name:JEFFREY P. AUSTIN, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-447-9441
Mailing Address - Street 1:3000 S BERRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7472
Mailing Address - Country:US
Mailing Address - Phone:405-447-9441
Mailing Address - Fax:405-447-9456
Practice Address - Street 1:3000 S BERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-7472
Practice Address - Country:US
Practice Address - Phone:405-447-9441
Practice Address - Fax:405-447-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5413261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100224470AMedicaid