MEDICARE: DR. KIMIA LALEZARI DMD

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	122300000X	Dentist	24141	FL
2	1223G0001X	General Practice Dentistry	24141	FL
3	1223G0001X	General Practice Dentistry	35199	TX

General Provider Information

NPI Number	:	1972163152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMIA LALEZARI DMD

Provider Business Mailing Address
First Line	:	1610 E PARMER LN STE E
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-7143
Country	:	US
Telephone Number	:	737-717-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 E PARMER LN STE E
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-7143
Country	:	US
Telephone Number	:	737-717-3500
Fax Number	:

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

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	04/13/2021

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