Provider Demographics
NPI:1245284082
Name:RAUCH, JOHN W (DDS02)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:RAUCH
Suffix:
Gender:M
Credentials:DDS02
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 HENDERSON LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9619
Mailing Address - Country:US
Mailing Address - Phone:270-737-8957
Mailing Address - Fax:
Practice Address - Street 1:2724 BRAVE RIFLES REGIMENT RD
Practice Address - Street 2:HQS US ARMY DENTAL ACTIVITY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-6158
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0144611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice