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NPI Code Detail

MEDICARE: RODEO EDINBURG & ORTHODONTICS, PLLC

MEDICARE: RODEO EDINBURG & ORTHODONTICS, PLLC
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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336594183
Entity Type Code : Organization
Provider Name (Legal Business Name) : RODEO EDINBURG & ORTHODONTICS, PLLC
Provider Business Mailing Address
First Line : 100 E 15TH ST STE 520
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-6566
Country : US
Telephone Number : 817-529-8151
Fax Number :
Provider Business Practice Location Address
First Line : 100 E 15TH ST STE 520
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-6566
Country : US
Telephone Number : 817-529-8151
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. SAAM ZARRABI
Credential :
Telephone Number : 817-529-8151
Provider Enumeration Date : 04/29/2016
Last Update Date : 04/29/2016

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Directions to “RODEO EDINBURG & ORTHODONTICS, PLLC ” Practice Location

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