MEDICARE: DR. YANN JULIEN RODENAS 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	9028	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019031132	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1992233266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANN JULIEN RODENAS DMD

Provider Business Mailing Address
First Line	:	968 1ST INFANTRY DIVISION RD
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5210
Country	:	US
Telephone Number	:	765-702-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	968 1ST INFANTRY DIVISION RD
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5210
Country	:	US
Telephone Number	:	765-702-1557
Fax Number	:

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

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	03/16/2023

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