Provider Demographics
NPI:1255560231
Name:RAUSCH, JEFFREY DAVID (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CHATTANOOGA AVE
Mailing Address - Street 2:APPT A116
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8884
Mailing Address - Country:US
Mailing Address - Phone:813-482-7665
Mailing Address - Fax:706-226-0996
Practice Address - Street 1:1002 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8340
Practice Address - Country:US
Practice Address - Phone:706-226-2606
Practice Address - Fax:706-226-0996
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist