MEDICARE: FLAVIO H RASETTO DDS MS PC

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
2	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1245690270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAVIO H RASETTO DDS MS PC

Provider Business Mailing Address
First Line	:	5454 WISCONSIN AVE
Second Line	:	SUITE 1500
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6922
Country	:	US
Telephone Number	:	301-652-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 WISCONSIN AVE
Second Line	:	SUITE 1500
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-6922
Country	:	US
Telephone Number	:	301-652-9717
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FLAVIO RASETTO
Credential	:	DDS, MS
Telephone Number	:	301-652-9717

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	03/03/2016

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