Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D093170 | MI |
NPI | 1023045960 |
---|---|
Provider Name | Dr. James E Austin |
First Address | Southfield, MI 48076 |
Second Address | Southfield, MI 48076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |