1750624110 NPI number — AUSTRIACO DENTAL ASSOCIATES LLC

Table of content: (NPI 1750624110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750624110 NPI number — AUSTRIACO DENTAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTRIACO DENTAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750624110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13220-3189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-273-8204
Provider Business Mailing Address Fax Number:
866-803-4943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7310 WALTON ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61108-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-273-8204
Provider Business Practice Location Address Fax Number:
866-803-4943
Provider Enumeration Date:
04/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTRIACO
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
866-273-8204

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019021311 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com