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NPI Code Detail

MEDICARE: DR. VICTOR E. RODMAN DDS

MEDICARE: DR. VICTOR E. RODMAN 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
11223P0221XPediatric Dentistry010601MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105705013OTHERMOBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1396739652
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTOR E. RODMAN DDS
Provider Business Mailing Address
First Line : 231 NW 72ND ST
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-1821
Country : US
Telephone Number : 816-436-7103
Fax Number :
Provider Business Practice Location Address
First Line : 231 NW 72ND ST
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-1821
Country : US
Telephone Number : 816-436-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 07/08/2007

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Directions to “ DR. VICTOR E. RODMAN DDS” Practice Location

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