Provider Demographics
NPI:1396077145
Name:RAUEN, PETE J (MMD)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:J
Last Name:RAUEN
Suffix:
Gender:M
Credentials:MMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3424
Mailing Address - Country:US
Mailing Address - Phone:859-331-8880
Mailing Address - Fax:859-331-7550
Practice Address - Street 1:232 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3424
Practice Address - Country:US
Practice Address - Phone:859-331-8880
Practice Address - Fax:859-331-7550
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8008071301Medicaid