Provider Demographics
NPI:1912116468
Name:AUSTIN, NOEL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1221
Mailing Address - Country:US
Mailing Address - Phone:207-474-2668
Mailing Address - Fax:207-474-2729
Practice Address - Street 1:66 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1221
Practice Address - Country:US
Practice Address - Phone:207-474-2668
Practice Address - Fax:207-474-2729
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice