Healthcare Provider Details

I. General information

NPI: 1417023235
Provider Name (Legal Business Name): EDMUND LEO RAPP D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 SOUTHPOINTE DR STE A2
INDIANAPOLIS IN
46227-1087
US

IV. Provider business mailing address

8937 SOUTHPOINTE DR STE A2
INDIANAPOLIS IN
46227-1087
US

V. Phone/Fax

Practice location:
  • Phone: 317-300-1744
  • Fax: 317-300-1967
Mailing address:
  • Phone: 317-300-1744
  • Fax: 317-300-1967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12008930A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: