| NPI | 1669596318 |
|---|---|
| Former Legal Business Name | AUSTIN DENTAL CLINIC PC |
| Entity Type | Organization |
| Authorized Contact | KENNETH LEE AUSTIN Manager 662-842-8035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 303298) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 298897) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2023-06-23 |