MEDICARE: RHEA PATE DMD

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	39978	TX

General Provider Information

NPI Number	:	1871375071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHEA PATE DMD

Provider Business Mailing Address
First Line	:	2808 TROPHY CLUB DR
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-3476
Country	:	US
Telephone Number	:	417-434-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	4833 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1428
Country	:	US
Telephone Number	:	817-294-4600
Fax Number	:

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

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	10/22/2023

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