MEDICARE: DR. BRIAN ALLEN ZARIKTA DDS

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	DD1216	NM
2	1223G0001X	General Practice Dentistry	11576	TX

General Provider Information

NPI Number	:	1235141235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN ALLEN ZARIKTA DDS

Provider Business Mailing Address
First Line	:	813 PARKLAND DR
Second Line	:
City	:	CLOVIS
State	:	NM
Zip	:	88101-4430
Country	:	US
Telephone Number	:	505-762-4501
Fax Number	:	505-762-7430

Provider Business Practice Location Address
First Line	:	813 PARKLAND DR
Second Line	:
City	:	CLOVIS
State	:	NM
Zip	:	88101-4430
Country	:	US
Telephone Number	:	505-762-4501
Fax Number	:	505-762-7430

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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