Provider Demographics
NPI:1003590092
Name:PFAHNING, RACHEL LILLIAN (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LILLIAN
Last Name:PFAHNING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 169TH ST W
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-9404
Mailing Address - Country:US
Mailing Address - Phone:218-371-8617
Mailing Address - Fax:
Practice Address - Street 1:5766 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2441
Practice Address - Country:US
Practice Address - Phone:651-457-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice