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Organization
BLAINE D. AUSTIN DDS INC.
Active
Organization
BLAINE D. AUSTIN DDS INC.
Active
Other names
Dr. Blaine D. Austin DDS
Organization subpart
No
Provider details
NPI number
Authorized official
BLAINE D AUSTIN DDS (ORAL MAXILLO-FACIAL SURGERY)
(801) 759-4378
Entity
Organization
Contact information
Practice address
1250 EAST 3900 SOUTH, SUITE 210, SALT LAKE CITY, UT 84124
(801) 264-1500
(801) 265-9963
Mailing address
1250 E 3900 S STE 210, SALT LAKE CITY, UT 84124-1367
(801) 265-1500
(801) 259-9963
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
140958
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
U000005310
—
UT
Enumeration date
12/19/2017
Last updated
01/08/2018
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