MEDICARE: DR. RUSSELL E KALIHER III DDS

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	20377	TX

General Provider Information

NPI Number	:	1730257015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL E KALIHER III DDS

Provider Business Mailing Address
First Line	:	4300 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3312
Country	:	US
Telephone Number	:	512-453-3100
Fax Number	:	512-453-4485

Provider Business Practice Location Address
First Line	:	4300 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3312
Country	:	US
Telephone Number	:	512-453-3100
Fax Number	:	512-453-4485

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/09/2007

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