MEDICARE: SIGNATURE SMILES, P.A.,

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	1223G0001X	General Practice Dentistry	22132	TX

General Provider Information

NPI Number	:	1033309091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE SMILES, P.A.,

Provider Business Mailing Address
First Line	:	5320 BURNET ROAD
Second Line	:	STE#108
City	:	AUSTIN
State	:	TX
Zip	:	78756
Country	:	US
Telephone Number	:	512-832-6225
Fax Number	:	512-832-8454

Provider Business Practice Location Address
First Line	:	5320 BURNET ROAD
Second Line	:	STE#108
City	:	AUSTIN
State	:	TX
Zip	:	78756
Country	:	US
Telephone Number	:	512-832-6225
Fax Number	:	512-832-8454

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD JOHN CALDWELL JR.
Credential	:	DDS
Telephone Number	:	512-832-6225

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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