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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