Individual
DR. KENNETH LEE AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3694 W JACKSON ST, TUPELO, MS 38801-7081
(662) 842-8035
(662) 842-3018
Mailing address
3694 W JACKSON ST, TUPELO, MS 38801-7081
(662) 842-8035
(662) 842-3018
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2988-97
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043405590
DELTA DENTAL
—
Enumeration date
09/07/2007
Last updated
04/18/2016
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