MEDICARE: TIMOTHY P RAUSCH DMD

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	122300000X	Dentist	DE015440	MO
2	122300000X	Dentist	DE-015440	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1629138425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY P RAUSCH DMD

Provider Business Mailing Address
First Line	:	PO BOX 250
Second Line	:	645 US HWY 61
City	:	NEW MADRID
State	:	MO
Zip	:	63869
Country	:	US
Telephone Number	:	573-748-2225
Fax Number	:	573-748-5655

Provider Business Practice Location Address
First Line	:	645 US HWY 61
Second Line	:
City	:	NEW MADRID
State	:	MO
Zip	:	63869
Country	:	US
Telephone Number	:	573-748-2225
Fax Number	:	573-748-5655

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/02/2011

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Directions to “ TIMOTHY P RAUSCH DMD” Practice Location

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