MEDICARE: RODERICK WILLIAM TATARYN D.D.S., M.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	1223E0200X	Endodontics	7248	WA
2	1223E0200X	Endodontics	37293	CA
3	1223E0200X	Endodontics	D3042	ID

General Provider Information

NPI Number	:	1386858587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK WILLIAM TATARYN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	2700 S SOUTHEAST BLVD
Second Line	:	SUITE 201
City	:	SPOKANE
State	:	WA
Zip	:	99223-4984
Country	:	US
Telephone Number	:	509-747-7665
Fax Number	:	509-747-0435

Provider Business Practice Location Address
First Line	:	2700 S SOUTHEAST BLVD
Second Line	:	SUITE 201
City	:	SPOKANE
State	:	WA
Zip	:	99223-4984
Country	:	US
Telephone Number	:	509-747-7665
Fax Number	:	509-747-0435

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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