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General NPI Number Information
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NPI Number | 1073901773
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Entity Type | Individual
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Provider Name | ROBERT GLEN RAPP EPDH
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Gender | Male
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Dates
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Enumeration Date | 01/03/2015
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Last Update Date | 01/03/2015
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Provider Practice Location Address
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Address Line | 2331 CRESTVIEW DR S
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City | SALEM
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State | OR
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Zip | 97302-5301
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Country | US
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Telephone | 971-599-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 CRESTVIEW DR S PO BOX 3161
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City | SALEM
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State | OR
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Zip | 97302-5301
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Country | US
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Telephone | 971-599-1214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H3591
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License Number State | OR
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