MEDICARE: RAQUEL MARKIE ROSS

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	7682	NV

General Provider Information

NPI Number	:	1497479414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL MARKIE ROSS

Provider Business Mailing Address
First Line	:	813 BILJAC ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6202
Country	:	US
Telephone Number	:	702-460-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6540 N LOSEE RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1001
Country	:	US
Telephone Number	:	702-360-8696
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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