Healthcare Provider Details

I. General information

NPI: 1053555888
Provider Name (Legal Business Name): ROBERT RAHM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 PENN AVE
SCRANTON PA
18503-1921
US

IV. Provider business mailing address

237 PENN AVE
SCRANTON PA
18503-1921
US

V. Phone/Fax

Practice location:
  • Phone: 917-288-3530
  • Fax:
Mailing address:
  • Phone: 917-288-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS037810
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: