MEDICARE: DR. ARLYNN GENISE RAEZ 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	1223P0300X	Periodontics	14117	TX
2	1223P0300X	Periodontics	40489	CA

General Provider Information

NPI Number	:	1871597146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARLYNN GENISE RAEZ DDS

Provider Business Mailing Address
First Line	:	3301 OAKWELL COURT
Second Line	:	SUITE #103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1778
Country	:	US
Telephone Number	:	210-805-8400
Fax Number	:	210-805-8450

Provider Business Practice Location Address
First Line	:	3301 OAKWELL COURT
Second Line	:	SUITE #103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1778
Country	:	US
Telephone Number	:	210-805-8400
Fax Number	:	210-805-8450

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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