MEDICARE: DR. DAVID H. RHODEN III 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	9741	TX
2	122300000X	Dentist	1128	AK

General Provider Information

NPI Number	:	1245363167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H. RHODEN III DDS

Provider Business Mailing Address
First Line	:	2098 N VALLEY MILLS DR
Second Line	:	STE. B
City	:	WACO
State	:	TX
Zip	:	76710-2586
Country	:	US
Telephone Number	:	254-399-0390
Fax Number	:	254-399-9854

Provider Business Practice Location Address
First Line	:	2098 N VALLEY MILLS DR
Second Line	:	STE. B
City	:	WACO
State	:	TX
Zip	:	76710-2586
Country	:	US
Telephone Number	:	254-399-0390
Fax Number	:	254-399-9854

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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