MEDICARE: BUTTERFLY PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386800738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERFLY PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 302
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-206-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MARATHON BLVD
Second Line	:	SUITE 302
City	:	AUSTIN
State	:	TX
Zip	:	78756-3436
Country	:	US
Telephone Number	:	512-206-2929
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. POONEH JAHADI
Credential	:	PHD
Telephone Number	:	512-206-2929

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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Directions to “BUTTERFLY PEDIATRIC DENTISTRY ” Practice Location

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