Provider Demographics
NPI:1659447480
Name:EDMUND L. RAPP, D.D.S., M.S.D., P.C.
Entity Type:Organization
Organization Name:EDMUND L. RAPP, D.D.S., M.S.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-887-7732
Mailing Address - Street 1:1350 E COUNTY LINE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0873
Mailing Address - Country:US
Mailing Address - Phone:317-887-7732
Mailing Address - Fax:317-887-7731
Practice Address - Street 1:1350 E COUNTY LINE RD
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0873
Practice Address - Country:US
Practice Address - Phone:317-887-7732
Practice Address - Fax:317-887-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000800A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental