Provider Demographics
NPI:1356571285
Name:RAPP, HENRY CONRAD III (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CONRAD
Last Name:RAPP
Suffix:III
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 1:161 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5823
Mailing Address - Country:US
Mailing Address - Phone:203-259-5026
Mailing Address - Fax:203-259-0001
Practice Address - Street 1:161 SHERMAN ST
Practice Address - Street 2:29
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5823
Practice Address - Country:US
Practice Address - Phone:203-259-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist