=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386725794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN L. RAUTIO DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 FOULK RD SUITE 204
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-762-6400
-----------------------------------------------------
Fax | 302-762-0208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 FOULK RD SUITE 204
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-762-6400
-----------------------------------------------------
Fax | 302-762-0208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | G5-0001122
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------