MEDICARE: DR. JUAN F RENDON DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	22083	TX

General Provider Information

NPI Number	:	1992824304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN F RENDON DDS, MS

Provider Business Mailing Address
First Line	:	840 CENTRAL PKWY E
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75074-5551
Country	:	US
Telephone Number	:	972-578-7800
Fax Number	:	972-867-9211

Provider Business Practice Location Address
First Line	:	4400 LITTLE RD
Second Line	:	SUITE 331A
City	:	ARLINGTON
State	:	TX
Zip	:	76016
Country	:	US
Telephone Number	:	972-578-7800
Fax Number	:	972-867-9211

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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