MEDICARE: DR. KIMBERLY ELLEN RAABE 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	1223G0001X	General Practice Dentistry	32994	TX
2	122300000X	Dentist	32994	TX

General Provider Information

NPI Number	:	1487184313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ELLEN RAABE DDS

Provider Business Mailing Address
First Line	:	2210 N FRAZIER ST STE 120
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1701
Country	:	US
Telephone Number	:	936-539-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 N FRAZIER ST STE 120
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1701
Country	:	US
Telephone Number	:	936-539-3636
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	10/23/2024

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