Individual
MATTHEW LAWRENCE RASCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S. M.S.D.
Contact information
Practice address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Mailing address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12011284A
IN
1223P0221X
Pediatric Dentistry
Primary
12011284A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201019080A
—
IN
Enumeration date
05/20/2009
Last updated
07/13/2011
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