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General NPI Number Information
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NPI Number | 1811377658
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Entity Type | Individual
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Provider Name | BRYAN CHARLES RATHKE DDS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER PKWY SUITE 400
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4945
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Country | US
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Telephone | 936-295-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 665 ELKINS LK
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City | HUNTSVILLE
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State | TX
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Zip | 77340-7316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30941
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30941
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License Number State | TX
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