Provider Demographics
NPI:1114282241
Name:REICHARD, RACHEL ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:REICHARD
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 1:2107 5TH STREET HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8977
Mailing Address - Country:US
Mailing Address - Phone:570-387-1243
Mailing Address - Fax:
Practice Address - Street 1:2107 5TH STREET HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8977
Practice Address - Country:US
Practice Address - Phone:570-387-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0390041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS039004OtherPENNSYLVANIA STATE BOARD OF DENTISTRY