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General NPI Number Information
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NPI Number | 1558435941
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Entity Type | Individual
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Provider Name | LARRY HERBERT RAPP D.D.S
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 500 SAINT LOUIS RD
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City | COLLINSVILLE
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State | IL
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Zip | 62234-2437
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Country | US
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Telephone | 618-345-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 2 OAK DR STE A
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City | MARYVILLE
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State | IL
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Zip | 62062-5809
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Country | US
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Telephone | 618-345-5011
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19A-15513
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License Number State | IL
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