MEDICARE: DR. REX D ESAU 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	5523	KS
2	122300000X	Dentist	24438	TX

General Provider Information

NPI Number	:	1518942242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REX D ESAU DDS

Provider Business Mailing Address
First Line	:	7201 RR 2222 APT 2112
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-3220
Country	:	US
Telephone Number	:	620-217-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 RR 2222 APT 2112
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78730-3220
Country	:	US
Telephone Number	:	620-217-5434
Fax Number	:

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	09/13/2012

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