Basic Information
Provider Information
NPI: 1871952135
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MESINA
FirstName: AUSTIN
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 12TH AVE S STE 901
Address2:  
City: SEATTLE
State: WA
PostalCode: 981442712
CountryCode: US
TelephoneNumber: 2065483114
FaxNumber: 2067626355
Practice Location
Address1: 6020 35TH AVE SW
Address2:  
City: SEATTLE
State: WA
PostalCode: 981263002
CountryCode: US
TelephoneNumber: 2064616966
FaxNumber: 2064616968
Other Information
ProviderEnumerationDate: 02/15/2016
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDE60771753WAY Dental ProvidersDentist 

No ID Information.


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