Provider Demographics
NPI:1285704882
Name:RAUCH, JON L (DMD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:L
Last Name:RAUCH
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 1:77 EIGHTH ST S
Mailing Address - Street 2:SUITE B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-4980
Mailing Address - Country:US
Mailing Address - Phone:239-403-7774
Mailing Address - Fax:239-403-7743
Practice Address - Street 1:19001 N. TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:N. FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903
Practice Address - Country:US
Practice Address - Phone:239-731-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics