MEDICARE: DR. TODD ROHDE 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DB-2023-0145	NM

General Provider Information

NPI Number	:	1649973868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD ROHDE DDS

Provider Business Mailing Address
First Line	:	3329 CUMING ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1947
Country	:	US
Telephone Number	:	505-452-6408
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 CUMING ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1947
Country	:	US
Telephone Number	:	505-452-6408
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	10/19/2023

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