MEDICARE: DR. REZA ARZEGAR 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	1223P0221X	Pediatric Dentistry	22434	TX

General Provider Information

NPI Number	:	1942229067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REZA ARZEGAR D.D.S.

Provider Business Mailing Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	SUITE#120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	512-371-8858
Fax Number	:	512-371-8860

Provider Business Practice Location Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	SUITE#120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	512-371-8858
Fax Number	:	512-371-8860

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	11/24/2014

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