MEDICARE: ROGER EDSON RETHERFORD 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	1223G0001X	General Practice Dentistry	16887	OH

General Provider Information

NPI Number	:	1487810586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER EDSON RETHERFORD D.D.S

Provider Business Mailing Address
First Line	:	1219 COUNTY LINE RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-6001
Country	:	US
Telephone Number	:	614-839-8000
Fax Number	:	614-839-8003

Provider Business Practice Location Address
First Line	:	1219 COUNTY LINE RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-6001
Country	:	US
Telephone Number	:	614-839-8000
Fax Number	:	614-839-8003

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	08/19/2008

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