Provider Demographics
NPI:1972505022
Name:RAUTER, KEVIN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLEN
Last Name:RAUTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16921 E PALISADES BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8411
Mailing Address - Country:US
Mailing Address - Phone:480-816-1011
Mailing Address - Fax:480-816-8063
Practice Address - Street 1:16921 E PALISADES BLVD
Practice Address - Street 2:STE 111
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8411
Practice Address - Country:US
Practice Address - Phone:480-816-1011
Practice Address - Fax:480-816-8063
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ43671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice