MEDICARE: DR. ANDREW RABER DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12012295A	IN
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10390	KY
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12012295A	IN

General Provider Information

NPI Number	:	1396125944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW RABER DDS, MSD

Provider Business Mailing Address
First Line	:	6583 PENNAN CT
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-8458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4315 COMMERCE DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-3822
Country	:	US
Telephone Number	:	765-588-0217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	01/06/2020

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