MEDICARE: DR. ROBERT BATES BLOMEYER II 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	122300000X	Dentist	9655	TX

General Provider Information

NPI Number	:	1922232917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BATES BLOMEYER II D.D.S.

Provider Business Mailing Address
First Line	:	5408 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4506
Country	:	US
Telephone Number	:	972-386-6200
Fax Number	:	972-386-9524

Provider Business Practice Location Address
First Line	:	5408 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4506
Country	:	US
Telephone Number	:	972-386-6200
Fax Number	:	972-386-9524

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

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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