MEDICARE: DR. OSBORNE JEFFERSON DYKES IV DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22118	TX

General Provider Information

NPI Number	:	1144419755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSBORNE JEFFERSON DYKES IV DDS, MS

Provider Business Mailing Address
First Line	:	1007 RR 620 S
Second Line	:	SUITE 201
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5634
Country	:	US
Telephone Number	:	512-633-7056
Fax Number	:	512-351-9829

Provider Business Practice Location Address
First Line	:	1007 RR 620 S
Second Line	:	SUITE 201
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5634
Country	:	US
Telephone Number	:	512-263-2993
Fax Number	:

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

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	09/26/2008

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