MEDICARE: R&Z DENTAL SERVICES,LLC

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	448615	PA

General Provider Information

NPI Number	:	1215172911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R&Z DENTAL SERVICES,LLC

Provider Business Mailing Address
First Line	:	1224 E HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4928
Country	:	US
Telephone Number	:	215-743-6685
Fax Number	:	215-743-6686

Provider Business Practice Location Address
First Line	:	1224 E HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4928
Country	:	US
Telephone Number	:	215-743-6685
Fax Number	:	215-743-6686

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. ILONA ZARICHNY
Credential	:
Telephone Number	:	215-743-6686

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	12/09/2008

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