Individual
MR. BOBBY WAYNE AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
246 E HWY 54, CAMDENTON, MO 65020
(573) 346-6062
(573) 346-3459
Mailing address
PO BOX 874, CAMDENTON, MO 65020
(573) 346-6062
(573) 346-3459
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12345
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40053551Y
—
MO
Enumeration date
10/31/2006
Last updated
07/08/2007
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