Provider Demographics
NPI:1043475858
Name:RACHAL, SHEREA BOWDEN (DMD)
Entity Type:Individual
Prefix:
First Name:SHEREA
Middle Name:BOWDEN
Last Name:RACHAL
Suffix:
Gender:F
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:PO BOX 12848
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315
Mailing Address - Country:US
Mailing Address - Phone:318-542-4004
Mailing Address - Fax:
Practice Address - Street 1:3439 MCGEHEE RD STE 22B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-3392
Practice Address - Country:US
Practice Address - Phone:334-288-1868
Practice Address - Fax:334-288-1825
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5913122300000X
ALD-0006849-C122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5913OtherLOUISIANA DENTAL LICENSE