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NPI Code Detail

MEDICARE: DR. SUSAN ANN RECTOR DDS

MEDICARE: DR. SUSAN ANN RECTOR 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
11223S0112XOral and Maxillofacial Surgery (Dentist)7839IA

Other Identifiers

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

General Provider Information

NPI Number : 1508832163
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN ANN RECTOR DDS
Provider Business Mailing Address
First Line : 2305 EAST 52 STREET
Second Line : SUITE 1
City : DAVENPORT
State : IA
Zip : 52807
Country : US
Telephone Number : 563-355-9424
Fax Number : 563-355-0180
Provider Business Practice Location Address
First Line : 2305 EAST 52 STREET
Second Line : SUITE 1
City : DAVENPORT
State : IA
Zip : 52807
Country : US
Telephone Number : 563-355-9424
Fax Number : 563-355-0180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 07/08/2007

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