MEDICARE: RAYMOND MICHAEL RODRIGUEZ 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	1223P0700X	Prosthodontics	22039TX	TX

General Provider Information

NPI Number	:	1649380072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND MICHAEL RODRIGUEZ DMD

Provider Business Mailing Address
First Line	:	5157 LAKE CREEK CT
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035
Country	:	US
Telephone Number	:	972-987-7076
Fax Number	:

Provider Business Practice Location Address
First Line	:	6009 BELTLINE RD
Second Line	:	SUITE 224
City	:	DALLAS
State	:	TX
Zip	:	75254
Country	:	US
Telephone Number	:	972-934-8255
Fax Number	:	972-934-8262

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/07/2018

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