Provider Demographics
NPI:1801247242
Name:LEDINGHAM, AUSTIN
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:LEDINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 CALUMET ST APT 33
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7594
Mailing Address - Country:US
Mailing Address - Phone:801-367-0890
Mailing Address - Fax:
Practice Address - Street 1:152 S 32ND ST W
Practice Address - Street 2:SUITE A
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6875
Practice Address - Country:US
Practice Address - Phone:406-245-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-114811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics