Provider Demographics
NPI:1780350702
Name:AUSTIN AESTHETICS
Entity type:Organization
Organization Name:AUSTIN AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YESSENIA
Authorized Official - Middle Name:ANABEL
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-604-0563
Mailing Address - Street 1:6018 24TH AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2627
Mailing Address - Country:US
Mailing Address - Phone:347-604-0563
Mailing Address - Fax:
Practice Address - Street 1:3745 89TH ST
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:347-604-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental