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General NPI Number Information
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NPI Number | 1699144022
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Entity Type | Organization
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Legal Business Name | RACKHAM DENTAL LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 6658 SUMMER FEST DRIVE
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City | SAN ANTONIO
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State | TX
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Zip | 78244
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Country | US
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Telephone | 801-920-8772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201315
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City | SAN ANTONIO
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State | TX
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Zip | 78220-8315
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Country | US
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Telephone | 801-920-8772
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSHUA LEE RACKHAM
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Credential | DMD
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Telephone | 801-920-8772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27186
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License Number State | TX
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