MEDICARE: DANIEL L. DREFKE, 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	261QD0000X	Dental Clinic/Center	12818	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1356768659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL L. DREFKE, D.D.S.

Provider Business Mailing Address
First Line	:	1104 W SAM HOUSTON BLVD STE A
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5104
Country	:	US
Telephone Number	:	956-781-0031
Fax Number	:	956-781-0202

Provider Business Practice Location Address
First Line	:	1104 W SAM HOUSTON BLVD STE A
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5104
Country	:	US
Telephone Number	:	956-781-0031
Fax Number	:	956-781-0202

Authorized Official
Title or Position	:	DENTIST/ OWNER
Name	:	DR. DANIEL LEWIS DREFKE
Credential	:
Telephone Number	:	956-781-0031

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	03/25/2014

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