Provider Demographics
NPI:1427154301
Name:AUSTIN, CAROL JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10709 W WAYZATA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5509
Mailing Address - Country:US
Mailing Address - Phone:952-544-5900
Mailing Address - Fax:952-544-5999
Practice Address - Street 1:10709 W WAYZATA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5509
Practice Address - Country:US
Practice Address - Phone:952-544-5900
Practice Address - Fax:952-544-5999
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND83831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice