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General NPI Number Information
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NPI Number | 1811426679
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Entity Type | Individual
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Provider Name | OLIVIA SUZANNE RAUSCHENBACH DDS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 3908 S NOLAND RD
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City | INDEPENDENCE
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State | MO
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Zip | 64055-3347
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Country | US
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Telephone | 816-461-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 200 WALNUT ST APT 304
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City | KANSAS CITY
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State | MO
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Zip | 64106-1024
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Country | US
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Telephone | 605-351-7611
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 61959
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2017017101
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License Number State | MO
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