MEDICARE: DR. KATIE HADDEN D.D.S.

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	1223G0001X	General Practice Dentistry	23216	TX

General Provider Information

NPI Number	:	1528266319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE HADDEN D.D.S.

Provider Business Mailing Address
First Line	:	3307 NORTHLAND DR STE 230
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4968
Country	:	US
Telephone Number	:	512-388-2220
Fax Number	:	512-388-2230

Provider Business Practice Location Address
First Line	:	3307 NORTHLAND DR STE 230
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4968
Country	:	US
Telephone Number	:	512-388-2220
Fax Number	:	512-388-2230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	01/09/2012

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