Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 18659 | OH |
NPI | 1003030248 |
---|---|
Provider Name | Dr. Mark P Austria |
First Address | Highland Heights, OH 44143-2128 |
Second Address | Highland Heights, OH 44143-2128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |