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General NPI Number Information
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NPI Number | 1265582282
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Entity Type | Individual
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Provider Name | RICHARD ANTHONY RACANELLI DMD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 6410 MEDICAL CENTER ST STE B
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City | LAS VEGAS
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State | NV
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Zip | 89148-2401
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Country | US
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Telephone | 702-736-0016
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Fax | 702-736-0057
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Provider Business Mailing Address
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Address Line | 6410 MEDICAL CENTER ST STE B
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City | LAS VEGAS
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State | NV
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Zip | 89148-2401
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Country | US
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Telephone | 702-736-0016
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Fax | 702-736-0057
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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
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License Number | 6264
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License Number State | NV
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