MEDICARE: DR. KENNETH CHARLES MACALUSO DDS

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	13364	TX

General Provider Information

NPI Number	:	1831300110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH CHARLES MACALUSO DDS

Provider Business Mailing Address
First Line	:	1738 N MAYS
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664
Country	:	US
Telephone Number	:	512-244-2414
Fax Number	:	512-244-2477

Provider Business Practice Location Address
First Line	:	1738 N MAYS
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664
Country	:	US
Telephone Number	:	512-244-2414
Fax Number	:	512-244-2477

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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