Provider Demographics
NPI:1104916527
Name:AUSTIN FAMILY DENTAL LTD
Entity type:Organization
Organization Name:AUSTIN FAMILY DENTAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-641-1908
Mailing Address - Street 1:1360 ENERGY PARK DR
Mailing Address - Street 2:#104
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5252
Mailing Address - Country:US
Mailing Address - Phone:651-641-1908
Mailing Address - Fax:651-641-1907
Practice Address - Street 1:1360 ENERGY PARK DR
Practice Address - Street 2:#104
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5252
Practice Address - Country:US
Practice Address - Phone:651-641-1908
Practice Address - Fax:651-641-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND098111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty