MEDICARE: DR. BOBBY W. RAGAN D.D.S.

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	14681	TX

General Provider Information

NPI Number	:	1659421196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY W. RAGAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:
City	:	DETROIT
State	:	TX
Zip	:	75436-0086
Country	:	US
Telephone Number	:	903-674-5165
Fax Number	:	903-674-5165

Provider Business Practice Location Address
First Line	:	195 FIRST ST. SOUTHWEST
Second Line	:
City	:	DETROIT
State	:	TX
Zip	:	75436
Country	:	US
Telephone Number	:	903-674-5165
Fax Number	:	903-674-5165

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. BOBBY W. RAGAN D.D.S.” Practice Location

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