MEDICARE: JONATHAN M RASMUSSEN 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	1223P0700X	Prosthodontics	73307789922	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811964521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M RASMUSSEN DDS

Provider Business Mailing Address
First Line	:	7410 CREEK RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6140
Country	:	US
Telephone Number	:	801-352-7889
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 CREEK RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-6140
Country	:	US
Telephone Number	:	801-352-7889
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	11/23/2009

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