MEDICARE: DR. MOLLIE HELAINE KENTOR 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	20611	TX

General Provider Information

NPI Number	:	1912011750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLIE HELAINE KENTOR DDS

Provider Business Mailing Address
First Line	:	4807 SPICEWOOD SPRINGS RD
Second Line	:	BLDG. 1, STE. 1260
City	:	AUSTIN
State	:	TX
Zip	:	78759-8444
Country	:	US
Telephone Number	:	512-349-1900
Fax Number	:	512-349-1901

Provider Business Practice Location Address
First Line	:	4807 SPICEWOOD SPRINGS RD
Second Line	:	BLDG. 1, STE. 1260
City	:	AUSTIN
State	:	TX
Zip	:	78759-8444
Country	:	US
Telephone Number	:	512-349-1900
Fax Number	:	512-349-1901

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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