Provider Demographics
NPI:1801463989
Name:RAUSCH, JOHN MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:RAUSCH
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 1:33 DOC KIMBALL WAY
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6491
Mailing Address - Country:US
Mailing Address - Phone:406-614-2020
Mailing Address - Fax:
Practice Address - Street 1:33 DOC KIMBALL WAY
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6491
Practice Address - Country:US
Practice Address - Phone:406-614-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-214251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice