MEDICARE: DR. RITA M DEVORE 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	1223G0001X	General Practice Dentistry	D3555	ID

General Provider Information

NPI Number	:	1962460030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA M DEVORE DDS

Provider Business Mailing Address
First Line	:	11205 BROOK BEND CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-2393
Country	:	US
Telephone Number	:	502-962-3972
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 BRAVE RIFLES REGIMENT RD
Second Line	:
City	:	FT KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	502-624-7313
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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