MEDICARE: JOSEPH J. BOOTH, DMD, PC

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	24222	TX

General Provider Information

NPI Number	:	1053644310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH J. BOOTH, DMD, PC

Provider Business Mailing Address
First Line	:	10009 NORTH LAMAR BLVD
Second Line	:	SUITE C
City	:	AUSTIN
State	:	TX
Zip	:	78753-4117
Country	:	US
Telephone Number	:	512-491-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	10009 NORTH LAMAR BLVD
Second Line	:	SUITE C
City	:	AUSTIN
State	:	TX
Zip	:	78753-4117
Country	:	US
Telephone Number	:	512-491-7800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH BOOTH
Credential	:	DMD
Telephone Number	:	512-432-5147

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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