MEDICARE: DR. KURT E. DELIUS D.D.S., M.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	1223P0300X	Periodontics	16698	TX

General Provider Information

NPI Number	:	1609878321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT E. DELIUS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	10123 LAKE CREEK PKWY
Second Line	:	BLDG 1
City	:	AUSTIN
State	:	TX
Zip	:	78729-1755
Country	:	US
Telephone Number	:	512-266-8381
Fax Number	:

Provider Business Practice Location Address
First Line	:	10123 LAKE CREEK PKWY
Second Line	:	BUILDING 1
City	:	AUSTIN
State	:	TX
Zip	:	78729-1754
Country	:	US
Telephone Number	:	512-335-3600
Fax Number	:	512-335-9771

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/15/2016

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