Provider Demographics
NPI:1417023235
Name:RAPP, EDMUND LEO (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:LEO
Last Name:RAPP
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 SOUTHPOINTE DR STE A2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1087
Mailing Address - Country:US
Mailing Address - Phone:317-300-1744
Mailing Address - Fax:317-300-1967
Practice Address - Street 1:8937 SOUTHPOINTE DR STE A2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1087
Practice Address - Country:US
Practice Address - Phone:317-300-1744
Practice Address - Fax:317-300-1967
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008930A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics