MEDICARE: DR. CORY BRANDON RAUCH 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	122300000X	Dentist	7322	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174714885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY BRANDON RAUCH DMD

Provider Business Mailing Address
First Line	:	2820 E UNIVERSITY DR
Second Line	:	SUITE #108
City	:	MESA
State	:	AZ
Zip	:	85213-8500
Country	:	US
Telephone Number	:	480-361-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 E UNIVERSITY DR
Second Line	:	SUITE #108
City	:	MESA
State	:	AZ
Zip	:	85213-8500
Country	:	US
Telephone Number	:	480-361-4923
Fax Number	:

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

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	12/15/2016

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