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General NPI Number Information
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NPI Number | 1154418531
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Entity Type | Individual
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Provider Name | GARY S RAPPAPORT DMD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 90 HALL DR
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City | ORANGE
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State | CT
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Zip | 06477-2543
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Country | US
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Telephone | 203-795-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 80 PHOENIX AVE STE 201
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City | WATERBURY
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State | CT
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Zip | 06702-1418
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Country | US
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Telephone | 203-756-8021
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Fax | 203-597-8860
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3841
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License Number State | CT
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