MEDICARE: RIO DENTAL, PLLC

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	29870	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29870	OTHER	TX	TSBDE

General Provider Information

NPI Number	:	1518351048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIO DENTAL, PLLC

Provider Business Mailing Address
First Line	:	2811 HILLCREST DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-7047
Country	:	US
Telephone Number	:	210-785-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 HILLCREST DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-7047
Country	:	US
Telephone Number	:	210-785-8526
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIMBERLY CUDDY
Credential	:	D.D.S
Telephone Number	:	210-785-8526

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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Directions to “RIO DENTAL, PLLC ” Practice Location

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