Provider Demographics
NPI:1235354895
Name:DRS. GERALD AND CANDACE RAUSCH, PC
Entity Type:Organization
Organization Name:DRS. GERALD AND CANDACE RAUSCH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-931-3388
Mailing Address - Street 1:1172 ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2903
Mailing Address - Country:US
Mailing Address - Phone:770-931-3388
Mailing Address - Fax:770-931-3368
Practice Address - Street 1:1172 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2903
Practice Address - Country:US
Practice Address - Phone:770-931-3388
Practice Address - Fax:770-931-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98291223G0001X
GA96561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty