Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2901600842 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | DL12217 | MA |
NPI | 1538574009 |
---|---|
Provider Name | Dr. Austin Be |
First Address | Warren, MI 48092-5667 |
Second Address | Livonia, MI 48154-6109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 10/10/2021 |