MEDICARE: RURAL DENTAL CARE SOLUTIONS, PLLC

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	22374	TX

General Provider Information

NPI Number	:	1174967806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL DENTAL CARE SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	101 LANTANA HOLW
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-5889
Country	:	US
Telephone Number	:	830-229-5403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 N MAIN ST
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-3041
Country	:	US
Telephone Number	:	830-688-3253
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. RICHARD MENZ
Credential	:	D.D.S.
Telephone Number	:	830-688-3253

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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