MEDICARE: DR. RENE ALEJANDRO RODRIGUEZ FARRACH D.M.D

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	DS037704	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26467	OTHER	TX	TEXAS STATE BOARD OF DENTAL EXAMINERS
2	DS037704	OTHER	PA	PENNSYLVANIA STATE BOARD OF DENTISTRY

General Provider Information

NPI Number	:	1295980944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE ALEJANDRO RODRIGUEZ FARRACH D.M.D

Provider Business Mailing Address
First Line	:	11682 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	832-457-4051
Fax Number	:

Provider Business Practice Location Address
First Line	:	11682 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	832-457-4051
Fax Number	:

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

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	06/17/2013

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