Provider Demographics
NPI:1669032132
Name:AUSTIN, DYLAN LOUIS (DDS)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:LOUIS
Last Name:AUSTIN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 89TH ST BSMT
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7843
Mailing Address - Country:US
Mailing Address - Phone:347-604-0563
Mailing Address - Fax:
Practice Address - Street 1:3745 89TH ST BSMT
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7843
Practice Address - Country:US
Practice Address - Phone:347-604-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice