MEDICARE: ALI GOLSHANI 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	122300000X	Dentist	31091	TX

General Provider Information

NPI Number	:	1790167617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI GOLSHANI D.D.S.

Provider Business Mailing Address
First Line	:	5329 SERENE HILLS DR STE 104
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1257
Country	:	US
Telephone Number	:	512-334-0345
Fax Number	:	512-870-9803

Provider Business Practice Location Address
First Line	:	5329 SERENE HILLS DR STE 104
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1257
Country	:	US
Telephone Number	:	512-334-0345
Fax Number	:	512-870-9803

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

Provider Enumeration Date	:	06/27/2015
Last Update Date	:	03/20/2018

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Directions to “ ALI GOLSHANI D.D.S.” Practice Location

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