MEDICARE: RDM DMD INC

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	5559	NV

General Provider Information

NPI Number	:	1093991481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RDM DMD INC

Provider Business Mailing Address
First Line	:	2540 S TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5137
Country	:	US
Telephone Number	:	702-367-9599
Fax Number	:	702-367-2958

Provider Business Practice Location Address
First Line	:	2540 S TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5137
Country	:	US
Telephone Number	:	702-367-9599
Fax Number	:	702-367-2958

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REWADEE MEEVASIN
Credential	:	D.M.D
Telephone Number	:	702-367-9599

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	06/17/2008

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