MEDICARE: DR. RIZALINO O YRAY JR. D.D.S.

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	4462015	WI

General Provider Information

NPI Number	:	1124147434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIZALINO O YRAY JR. D.D.S.

Provider Business Mailing Address
First Line	:	205 W SADD STREET
Second Line	:
City	:	NORTH PRAIRIE
State	:	WI
Zip	:	53153-0404
Country	:	US
Telephone Number	:	262-392-2244
Fax Number	:	262-510-2441

Provider Business Practice Location Address
First Line	:	205 W SADD ST
Second Line	:
City	:	NORTH PRAIRIE
State	:	WI
Zip	:	53153
Country	:	US
Telephone Number	:	262-392-2244
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	02/27/2014

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