Basic Information
| Provider Information | |||||||||
| NPI: | 1740611706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK C. AUSTIN OMFS, PLLC | ||||||||
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| OtherOrganizationName: | AUSTIN ORAL & MAXILLOFACIAL SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 SOUTH BAXTER DR. | ||||||||
| Address2: | |||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107691605 | ||||||||
| FaxNumber: | 9107691209 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SOUTH BAXTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107691605 | ||||||||
| FaxNumber: | 9107691209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2013 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | DAVID | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9102313134 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204E00000X | 7348 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery |
No ID Information.