MEDICARE: ELIZABETH WOELL RHODE 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	122300000X	Dentist	D13559	MN

General Provider Information

NPI Number	:	1336521806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WOELL RHODE D.D.S.

Provider Business Mailing Address
First Line	:	1717 E 66TH ST
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 E 66TH ST
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2722
Country	:	US
Telephone Number	:	612-861-7109
Fax Number	:

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

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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