Active NPI
Austin Mahlik, DDS
- Dentist
- San Diego, CA
National Provider Identifier
1174194609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1002561-15
- Practice address
- 34800 Bob Wilson Dr
San Diego, CA 92134-1098 - Phone
- (619) 532-6400
- NPI assigned
- Jul 6, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1002561 | WI | |
| Dentist | 122300000X | 1002561-15 | WI | Primary |
Addresses
Primary practice location
34800 Bob Wilson Dr
San Diego, CA 92134-1098
Mailing address
1320 S 1St St Unit 305
Milwaukee, WI 53204-2475
Phone (715) 923-5350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1002561 | WI | MD | Dentist |
| 1002561-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1174194609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 S 1ST ST UNIT 305",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532042475",
"telephone_number": "715-923-5350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34800 BOB WILSON DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921341098",
"telephone_number": "619-532-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHLIK",
"first_name": "AUSTIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-06",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1002561",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1002561-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.