MEDICARE: DR. RODNEY DALE ENTREKIN D.M.D.

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	3497	AL

General Provider Information

NPI Number	:	1598852527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY DALE ENTREKIN D.M.D.

Provider Business Mailing Address
First Line	:	7022 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1370
Country	:	US
Telephone Number	:	334-271-3111
Fax Number	:	334-271-3112

Provider Business Practice Location Address
First Line	:	7022 VAUGHN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1370
Country	:	US
Telephone Number	:	334-271-3111
Fax Number	:	334-271-3112

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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