MEDICARE: DR. GERALD E RAYBECK DDS, MBA, MAGD

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	4173	NV
2	1223G0001X	General Practice Dentistry	DS023860L	PA
3	1223G0001X	General Practice Dentistry	M858	SD

General Provider Information

NPI Number	:	1669430443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD E RAYBECK DDS, MBA, MAGD

Provider Business Mailing Address
First Line	:	901 RANCHO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3836
Country	:	US
Telephone Number	:	702-636-3060
Fax Number	:	702-636-3057

Provider Business Practice Location Address
First Line	:	901 RANCHO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3836
Country	:	US
Telephone Number	:	702-636-3060
Fax Number	:	702-636-3057

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	07/10/2007

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