MEDICARE: RAYFORD DENTAL, LLP

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

General Provider Information

NPI Number	:	1063783439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYFORD DENTAL, LLP

Provider Business Mailing Address
First Line	:	2211 RAYFORD RD
Second Line	:	#113
City	:	SPRING
State	:	TX
Zip	:	77386-1555
Country	:	US
Telephone Number	:	281-362-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 RAYFORD RD
Second Line	:	#113
City	:	SPRING
State	:	TX
Zip	:	77386-1555
Country	:	US
Telephone Number	:	281-362-1222
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JASON M DERR
Credential	:	DDS
Telephone Number	:	281-443-7524

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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