MEDICARE: AUSTIN FAMILY DENTISTRY PPLC

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

General Provider Information

NPI Number	:	1821315227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN FAMILY DENTISTRY PPLC

Provider Business Mailing Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	818-620-1411
Fax Number	:	512-402-9986

Provider Business Practice Location Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	818-620-1411
Fax Number	:	512-402-9986

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. REZA ARZEGAR
Credential	:	DDS
Telephone Number	:	818-620-1411

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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