Provider Demographics
NPI:1811426679
Name:RAUSCHENBACH, OLIVIA SUZANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:SUZANNE
Last Name:RAUSCHENBACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WALNUT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1024
Mailing Address - Country:US
Mailing Address - Phone:605-351-7611
Mailing Address - Fax:
Practice Address - Street 1:3908 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3347
Practice Address - Country:US
Practice Address - Phone:816-461-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61959122300000X
MO20170171011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist