MEDICARE: DENTAL CENTER OF SOUTH AUSTIN, P.C.

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	19831	TX

General Provider Information

NPI Number	:	1326257858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL CENTER OF SOUTH AUSTIN, P.C.

Provider Business Mailing Address
First Line	:	7010 W HIGHWAY 71
Second Line	:	STE 225
City	:	AUSTIN
State	:	TX
Zip	:	78735-8300
Country	:	US
Telephone Number	:	512-288-0400
Fax Number	:	512-288-0482

Provider Business Practice Location Address
First Line	:	7010 W HIGHWAY 71
Second Line	:	STE 225
City	:	AUSTIN
State	:	TX
Zip	:	78735-8300
Country	:	US
Telephone Number	:	512-288-0400
Fax Number	:	512-288-0482

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAGNOLIA MAGGIE SHARFAE
Credential	:	D.D.S.
Telephone Number	:	512-288-0400

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/15/2008

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