MEDICARE: STEPHEN A RAPPEPORT DDS

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	1223P0300X	Periodontics	2241	AR

General Provider Information

NPI Number	:	1689626269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN A RAPPEPORT DDS

Provider Business Mailing Address
First Line	:	304 N GREENWOOD AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3454
Country	:	US
Telephone Number	:	479-783-3633
Fax Number	:	479-783-3637

Provider Business Practice Location Address
First Line	:	304 N GREENWOOD AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3454
Country	:	US
Telephone Number	:	479-783-3633
Fax Number	:	479-783-3637

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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Directions to “ STEPHEN A RAPPEPORT DDS” Practice Location

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