Provider Demographics
NPI:1073901773
Name:RAPP, ROBERT GLEN (EPDH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GLEN
Last Name:RAPP
Suffix:
Gender:M
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CRESTVIEW DR S
Mailing Address - Street 2:PO BOX 3161
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5301
Mailing Address - Country:US
Mailing Address - Phone:971-599-1214
Mailing Address - Fax:
Practice Address - Street 1:2331 CRESTVIEW DR S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5301
Practice Address - Country:US
Practice Address - Phone:971-599-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3591124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist