Provider Demographics
NPI:1962843961
Name:RAPP, MANNY (DDS)
Entity type:Individual
Prefix:DR
First Name:MANNY
Middle Name:
Last Name:RAPP
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 1:1701 N. GREEN VALLEY PKWY #8E
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-492-1955
Mailing Address - Fax:702-492-7663
Practice Address - Street 1:1701 N. GREEN VALLEY PKWY #8E
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074
Practice Address - Country:US
Practice Address - Phone:702-492-1955
Practice Address - Fax:702-492-7663
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-261223P0221X
NV37421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS6-26OtherSPECIALTY LICENSE
NV3742OtherSTATE DENTAL LIC NUMBER
02-0637337OtherTAX ID #