MEDICARE: JOHN CALVERT, DDS DBA SMILE CREATIONS DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	14733	TX

General Provider Information

NPI Number	:	1316092877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN CALVERT, DDS DBA SMILE CREATIONS DENTAL

Provider Business Mailing Address
First Line	:	3022 SLAUGHTER LN W
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5704
Country	:	US
Telephone Number	:	512-280-8800
Fax Number	:	512-280-5088

Provider Business Practice Location Address
First Line	:	3022 SLAUGHTER LN W
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5704
Country	:	US
Telephone Number	:	512-280-8800
Fax Number	:	512-280-5088

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. JOHN F. CALVERT
Credential	:	DDS
Telephone Number	:	512-280-8800

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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