MEDICARE: RAHUL G KODE 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	5479	AZ

General Provider Information

NPI Number	:	1518087246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHUL G KODE DDS

Provider Business Mailing Address
First Line	:	2046 E SALTSAGE DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-8104
Country	:	US
Telephone Number	:	602-909-7103
Fax Number	:	480-753-5296

Provider Business Practice Location Address
First Line	:	4855 E WARNER RD
Second Line	:	STE B-9
City	:	PHOENIX
State	:	AZ
Zip	:	85044-3308
Country	:	US
Telephone Number	:	480-753-9063
Fax Number	:	580-753-5296

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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