MEDICARE: DR. ROBERT CARROLL CODY DMD

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	10952	TX

General Provider Information

NPI Number	:	1053314732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CARROLL CODY DMD

Provider Business Mailing Address
First Line	:	13701 NORTHWEST BLVD
Second Line	:	STE B3
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5114
Country	:	US
Telephone Number	:	361-387-3559
Fax Number	:	361-387-1286

Provider Business Practice Location Address
First Line	:	13701 NORTHWEST BLVD
Second Line	:	STE B3
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-5114
Country	:	US
Telephone Number	:	361-387-3559
Fax Number	:	361-387-1286

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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