MEDICARE: THE AUSTIN DENTIST, PLLC

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	24632	TX
2	124Q00000X	Dental Hygienist	16782	TX
3	124Q00000X	Dental Hygienist	16813	TX
4	122300000X	Dentist	21136	TX

General Provider Information

NPI Number	:	1538507181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AUSTIN DENTIST, PLLC

Provider Business Mailing Address
First Line	:	5701 W SLAUGHTER LN
Second Line	:	SUITE B120
City	:	AUSTIN
State	:	TX
Zip	:	78749-6527
Country	:	US
Telephone Number	:	512-467-4722
Fax Number	:	512-467-4768

Provider Business Practice Location Address
First Line	:	5701 W SLAUGHTER LN
Second Line	:	SUITE B120
City	:	AUSTIN
State	:	TX
Zip	:	78749-6527
Country	:	US
Telephone Number	:	512-467-4722
Fax Number	:	512-467-4768

Authorized Official
Title or Position	:	DR. HORNE
Name	:	DR. MATTHEW HORNE
Credential	:	DDS
Telephone Number	:	512-467-4722

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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