Gary Robert Raccuglia, DDS
Individual provider Active NPI Dentist · Wellsville, KS
NPI 1083749527 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083749527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5323 (KS)
- Practice address
- 501 Main St
Wellsville, KS 66092-8724 - Phone
- (785) 883-2222
- NPI assigned
- Feb 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5323 | KS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellsville Family Dental, P.a. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5323 | KS | Yes |
Addresses
Primary practice location
501 Main St
Wellsville, KS 66092-8724
Mailing address
6812 W 125TH St
Overland Park, KS 66209-2586
Phone (913) 345-9122
Other providers in Wellsville, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.