Provider Demographics
NPI:1427171552
Name:AUSTIN, LOUIS THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THOMAS
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 ENERGY PARK DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5276
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:SUITE 140
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5276
Practice Address - Country:US
Practice Address - Phone:651-641-1908
Practice Address - Fax:651-641-1907
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMND98111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice