Basic Information
| Provider Information | |||||||||
| NPI: | 1154418531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAPPAPORT | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 PHOENIX AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037568021 | ||||||||
| FaxNumber: | 2035978860 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 HALL DR | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064772543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037956621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 3841 | CT | Y | Dental Providers | Dentist | General Practice |
No ID Information.