MEDICARE: DR. RODNEY JENE GOLD 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	122300000X	Dentist	D3398	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	092578	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1346256252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY JENE GOLD DDS

Provider Business Mailing Address
First Line	:	899 N WILMOT
Second Line	:	STE A-2
City	:	TUCSON
State	:	AZ
Zip	:	85711-1712
Country	:	US
Telephone Number	:	520-790-9100
Fax Number	:	520-790-0809

Provider Business Practice Location Address
First Line	:	899 N WILMOT
Second Line	:	STE A-2
City	:	TUCSON
State	:	AZ
Zip	:	85711-1712
Country	:	US
Telephone Number	:	520-790-9100
Fax Number	:	520-790-0809

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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