Healthcare Provider Details

I. General information

NPI: 1689626269
Provider Name (Legal Business Name): STEPHEN A RAPPEPORT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

IV. Provider business mailing address

304 N GREENWOOD AVE
FORT SMITH AR
72901-3454
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-3633
  • Fax: 479-783-3637
Mailing address:
  • Phone: 479-783-3633
  • Fax: 479-783-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2241
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: