=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447524202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACRHO CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2012
-----------------------------------------------------
Last Update Date | 02/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11700 PRESTON RD 660134
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-6112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-207-2705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 743114
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75374-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES., DENTIST
-----------------------------------------------------
Name | DR. KING RHODES
-----------------------------------------------------
Credential | D.D.S., M.P.H.
-----------------------------------------------------
Telephone | 972-207-2705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 13683
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------