Provider Demographics
NPI:1679614234
Name:RAPOPORT, ALLA (DDS)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:RAPOPORT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 CANBY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2953
Mailing Address - Country:US
Mailing Address - Phone:818-774-9933
Mailing Address - Fax:818-774-9939
Practice Address - Street 1:7601 CANBY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2953
Practice Address - Country:US
Practice Address - Phone:818-774-9933
Practice Address - Fax:818-774-9939
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93289-01OtherDENTI-CAL PROVIDER NUMBER
CA27-1134685OtherTAX ID
CA48358OtherDENTAL LICENSE NUMBER
CAG93289-01OtherDENTI-CAL PROVIDER NUMBER