Provider Demographics
NPI:1659783603
Name:AUSTIN, BRIANA BROOKE (DDS)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:BROOKE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:BRIANA
Other - Middle Name:BROOKE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:361 THE GREENS CIR
Mailing Address - Street 2:APT. 303
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5255
Mailing Address - Country:US
Mailing Address - Phone:919-323-6108
Mailing Address - Fax:
Practice Address - Street 1:70 CRAPE MYRTLE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:919-938-0875
Practice Address - Fax:919-934-0266
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist