MEDICARE: DR. RAFAEL D CEPEDA DDS

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	DN17040	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205084472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL D CEPEDA DDS

Provider Business Mailing Address
First Line	:	305 E UNION ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2748
Country	:	US
Telephone Number	:	904-717-9161
Fax Number	:	904-717-9167

Provider Business Practice Location Address
First Line	:	305 E UNION ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2748
Country	:	US
Telephone Number	:	904-717-9161
Fax Number	:	904-717-9167

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

Provider Enumeration Date	:	08/30/2008
Last Update Date	:	04/06/2018

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