Provider Demographics
NPI:1710142625
Name:RAPOZAFAMILY DENTISTRY
Entity Type:Organization
Organization Name:RAPOZAFAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:RAPOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-532-5008
Mailing Address - Street 1:880 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-7183
Mailing Address - Country:US
Mailing Address - Phone:610-532-5008
Mailing Address - Fax:610-532-2459
Practice Address - Street 1:1319 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1216
Practice Address - Country:US
Practice Address - Phone:610-532-5008
Practice Address - Fax:610-532-2459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAPOZA FAMILY DENTISITRY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025682L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty