Provider Demographics
NPI:1972512044
Name:RAPP, WILLIAM KING JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KING
Last Name:RAPP
Suffix:JR
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 1:424 BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-5118
Mailing Address - Country:US
Mailing Address - Phone:209-826-4237
Mailing Address - Fax:
Practice Address - Street 1:820 IOWA AVE
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3450
Practice Address - Country:US
Practice Address - Phone:209-826-9176
Practice Address - Fax:209-826-7626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27190OtherDENTAL LICENSE