MEDICARE: DR. RICHARD ANTHONY RACANELLI 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	6264	NV

General Provider Information

NPI Number	:	1265582282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ANTHONY RACANELLI DMD

Provider Business Mailing Address
First Line	:	6410 MEDICAL CENTER ST STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2401
Country	:	US
Telephone Number	:	702-736-0016
Fax Number	:	702-736-0057

Provider Business Practice Location Address
First Line	:	6410 MEDICAL CENTER ST STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2401
Country	:	US
Telephone Number	:	702-736-0016
Fax Number	:	702-736-0057

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/17/2013

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