MEDICARE: DR. JENNIFER LYNN RAND D.D.S.

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	23427	TX

General Provider Information

NPI Number	:	1184800856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN RAND D.D.S.

Provider Business Mailing Address
First Line	:	175 RIDGE RD STE 100
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-5103
Country	:	US
Telephone Number	:	972-369-0700
Fax Number	:	972-369-0705

Provider Business Practice Location Address
First Line	:	175 RIDGE RD STE 100
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-5103
Country	:	US
Telephone Number	:	972-369-0700
Fax Number	:	972-369-0705

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

Provider Enumeration Date	:	01/12/2008
Last Update Date	:	01/12/2008

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