MEDICARE: DR. ROBIN D BETHELL 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	1223G0001X	General Practice Dentistry	57408	CA

General Provider Information

NPI Number	:	1790940880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN D BETHELL D.D.S.

Provider Business Mailing Address
First Line	:	2700 W ANDERSON LN UNIT 418
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1159
Country	:	US
Telephone Number	:	559-284-3079
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W ANDERSON LN UNIT 418
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1159
Country	:	US
Telephone Number	:	559-284-3079
Fax Number	:

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	01/23/2013

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