Provider Demographics
NPI:1003894791
Name:RACK, MICHAEL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:RACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66603-3061
Mailing Address - Country:US
Mailing Address - Phone:785-235-8779
Mailing Address - Fax:785-235-3223
Practice Address - Street 1:309 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3061
Practice Address - Country:US
Practice Address - Phone:785-235-8779
Practice Address - Fax:785-235-3223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice