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General NPI Number Information
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NPI Number | 1659447480
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Entity Type | Organization
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Legal Business Name | EDMUND L. RAPP, D.D.S., M.S.D., P.C.
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 E COUNTY LINE RD SUITE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-0873
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Country | US
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Telephone | 317-887-7732
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Fax | 317-887-7731
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Provider Business Mailing Address
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Address Line | 1350 E COUNTY LINE RD SUITE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-0873
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Country | US
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Telephone | 317-887-7732
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Fax | 317-887-7731
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDMUND LEO RAPP
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Credential | D.D.S., M.S.D.
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Telephone | 317-887-7732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54000800A
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License Number State | IN
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