Provider Demographics
NPI:1588810840
Name:RAPP, DAX (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAX
Middle Name:
Last Name:RAPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 E 22ND ST STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-5586
Mailing Address - Country:US
Mailing Address - Phone:520-748-3501
Mailing Address - Fax:
Practice Address - Street 1:5504 E 22ND ST STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5586
Practice Address - Country:US
Practice Address - Phone:520-748-3501
Practice Address - Fax:520-514-2277
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0080731223P0221X
UT4788760122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist