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General NPI Number Information
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NPI Number | 1306106646
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Entity Type | Organization
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Legal Business Name | JOSEPH J. BOOTH, D.M.D. II, P.C.
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 1030 NORWOOD PARK BLVD STE 324
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City | AUSTIN
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State | TX
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Zip | 78753-6609
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Country | US
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Telephone | 512-497-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 NORWOOD PARK BLVD STE 324
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City | AUSTIN
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State | TX
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Zip | 78753-6609
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Country | US
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Telephone | 512-491-3800
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Fax |
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Authorized Official
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Title or Position | DENTAL/OWNER
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Name | DR. JOSEPH BOOTH
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Credential | DMD
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Telephone | 512-491-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24222
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License Number State | TX
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