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NPI Code Detail

MEDICARE: DR. JERRY L. RACIOPPI D.D.S.

MEDICARE: DR. JERRY L. RACIOPPI 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
1122300000XDentistDN010822GA

General Provider Information

NPI Number : 1245431485
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY L. RACIOPPI D.D.S.
Provider Business Mailing Address
First Line : 2992 MAIN ST W
Second Line : SUITE A100
City : SNELLVILLE
State : GA
Zip : 30078-5764
Country : US
Telephone Number : 770-972-1039
Fax Number : 770-979-3903
Provider Business Practice Location Address
First Line : 2992 MAIN ST W
Second Line : SUITE A100
City : SNELLVILLE
State : GA
Zip : 30078-5764
Country : US
Telephone Number : 770-972-1039
Fax Number : 770-979-3903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 07/08/2007

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