Organization
AUSTIN FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MISTY L AUSTIN DMD (PRESIDENT)
(601) 634-6277
Entity
Organization
Contact information
Practice address
3040 INDIANA AVE, VICKSBURG, MS 39180
(601) 634-6277
Mailing address
3040 INDIANA AVE., VICKSBURG, MS 39180
(601) 634-6277
(601) 634-0153
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2063-84
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014287
—
MS
Enumeration date
05/22/2007
Last updated
10/01/2013
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