Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 24197 | TX |
Y | 1223P0221X | Pediatric Dentist | 24197 | TX |
NPI | 1053562413 |
---|---|
Provider Name | Dr. Allen Richard Rapolla II |
First Address | Dallas, TX 75220-4782 |
Second Address | Dallas, TX 75201-7041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2008 |
Last Update Date | 21/02/2018 |