MEDICARE: JOHNATHAN CALLIA

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	1223P0300X	Periodontics	20343	TX

General Provider Information

NPI Number	:	1063561686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN CALLIA

Provider Business Mailing Address
First Line	:	3701 KIRBY DR
Second Line	:	SUITE 550
City	:	HOUSTON
State	:	TX
Zip	:	77098-3900
Country	:	US
Telephone Number	:	512-328-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 S CAPITAL OF TEXAS HWY
Second Line	:	SUITE A-2
City	:	AUSTIN
State	:	TX
Zip	:	78746-8101
Country	:	US
Telephone Number	:	512-328-4867
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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Directions to “ JOHNATHAN CALLIA ” Practice Location

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