MEDICARE: DR. STEVEN LESLIE BOOTH DDS

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	18052	TX

General Provider Information

NPI Number	:	1043323603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN LESLIE BOOTH DDS

Provider Business Mailing Address
First Line	:	11851 JOLLYVILLE RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-345-8800
Fax Number	:	512-331-8500

Provider Business Practice Location Address
First Line	:	11851 JOLLYVILLE RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-2350
Country	:	US
Telephone Number	:	512-345-8800
Fax Number	:	512-331-8500

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/28/2017

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