Provider Demographics
NPI:1093727836
Name:TRUDELL, RACHEL LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LEIGH
Last Name:TRUDELL
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 1:1132 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2413
Mailing Address - Country:US
Mailing Address - Phone:860-236-6928
Mailing Address - Fax:860-236-6920
Practice Address - Street 1:1132 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2413
Practice Address - Country:US
Practice Address - Phone:860-236-6928
Practice Address - Fax:860-236-6920
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice