Provider Demographics
NPI:1750408985
Name:AUSTIN, DAVID G (DDS INC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE B 1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-451-3600
Mailing Address - Fax:614-451-3726
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE B 1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-451-3600
Practice Address - Fax:614-451-3726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016555122300000X, 2081P2900X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No122300000XDental ProvidersDentist
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0009218976OtherAETNA MEDICAL DME PIN
OH0436568Medicaid
OH30016555OtherDENTAL LICENSE
OH30016555OtherDENTAL LICENSE