Provider Demographics
NPI:1730597774
Name:AUSTIN, PHILIP CODY (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CODY
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 875
Mailing Address - Street 2:
Mailing Address - City:LINN CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65052-0875
Mailing Address - Country:US
Mailing Address - Phone:573-346-6062
Mailing Address - Fax:573-346-3459
Practice Address - Street 1:4176 EAST HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINN CREEK
Practice Address - State:MO
Practice Address - Zip Code:65052
Practice Address - Country:US
Practice Address - Phone:573-346-6062
Practice Address - Fax:573-346-3459
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist