MEDICARE: DR. ROBERT EVAN JOHN DDS, MHA

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	122300000X	Dentist	34382	TX

General Provider Information

NPI Number	:	1316414188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT EVAN JOHN DDS, MHA

Provider Business Mailing Address
First Line	:	515 S CONGRESS AVE STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1775
Country	:	US
Telephone Number	:	512-448-9669
Fax Number	:	512-448-9667

Provider Business Practice Location Address
First Line	:	515 S CONGRESS AVE STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1775
Country	:	US
Telephone Number	:	512-448-9669
Fax Number	:	512-448-9667

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	01/21/2026

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