Provider Demographics
NPI:1447260732
Name:RATHER, FREDERIC CLYDE (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:CLYDE
Last Name:RATHER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9042 COLUMBIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-5656
Mailing Address - Fax:219-836-0455
Practice Address - Street 1:9042 COLUMBIA AVE
Practice Address - Street 2:STE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-5656
Practice Address - Fax:219-836-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008608A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
609186400OtherOWCP