Healthcare Provider Details

I. General information

NPI: 1962843961
Provider Name (Legal Business Name): MANNY RAPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N. GREEN VALLEY PKWY #8E
HENDERSON NV
89074
US

IV. Provider business mailing address

1701 N. GREEN VALLEY PKWY #8E
HENDERSON NV
89074
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-1955
  • Fax: 702-492-7663
Mailing address:
  • Phone: 702-492-1955
  • Fax: 702-492-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-26
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3742
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: