MEDICARE: DR. JOHNNY LEWIS NANTZ JR. D.D.S

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	5069	NV
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22328	TX
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	18081	FL

General Provider Information

NPI Number	:	1609033141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY LEWIS NANTZ JR. D.D.S

Provider Business Mailing Address
First Line	:	3901 S LAMAR BLVD STE 420
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7990
Country	:	US
Telephone Number	:	512-445-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 S LAMAR BLVD STE 420
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7990
Country	:	US
Telephone Number	:	512-445-3355
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	06/22/2010

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