Organization
AUSTIN FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK S AUSTIN DDS (OWNER DENTIST)
(360) 882-1647
Entity
Organization
Contact information
Practice address
2100 SE 164TH AVE, #D102, VANCOUVER, WA 98683
(360) 882-1647
(360) 882-1446
Mailing address
2100 SE 164TH AVE, #D102, VANCOUVER, WA 98683
(360) 882-1647
(360) 882-1446
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE8705
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
999320
UNITED CONCORDIA TRICARE
—
Enumeration date
11/06/2006
Last updated
08/22/2020
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