MEDICARE: NEVIN KARKOUTLY ALLAN DMD

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	1223P0221X	Pediatric Dentistry	30348	TX

General Provider Information

NPI Number	:	1811270457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEVIN KARKOUTLY ALLAN DMD

Provider Business Mailing Address
First Line	:	12501 HYMEADOW DR
Second Line	:	STE. 1A
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	512-682-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 HYMEADOW DR
Second Line	:	STE 1A
City	:	AUSTIN
State	:	TX
Zip	:	78750-2263
Country	:	US
Telephone Number	:	512-682-5437
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	10/06/2014

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