Provider Demographics
NPI:1124491691
Name:BEAVERCREEK FAMILY DENTAL GREGORY J AUSTRIA DDS LLC
Entity type:Organization
Organization Name:BEAVERCREEK FAMILY DENTAL GREGORY J AUSTRIA DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AUSTRIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-376-9975
Mailing Address - Street 1:1289 N MONROE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1655
Mailing Address - Country:US
Mailing Address - Phone:937-376-9975
Mailing Address - Fax:937-376-8252
Practice Address - Street 1:4049 DAYTON XENIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-1992
Practice Address - Country:US
Practice Address - Phone:937-429-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty