Basic Information
| Provider Information | |||||||||
| NPI: | 1801247242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDINGHAM | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2605 CALUMET ST APT 33 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770047594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013670890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 152 S 32ND ST W | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591026875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062454414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | DEN-DEN-LIC-11481 | MT | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.