MEDICARE: DR. PAUL DAVID CORTEZ 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	D1055	SD

General Provider Information

NPI Number	:	1659786937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DAVID CORTEZ D.D.S.

Provider Business Mailing Address
First Line	:	3405 S CATHY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2702
Country	:	US
Telephone Number	:	800-516-7631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 S CATHY AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2702
Country	:	US
Telephone Number	:	800-516-7631
Fax Number	:

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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