Provider Demographics
NPI:1144583329
Name:BAXTER, RAQUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:BAXTER
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 1:7703 FLOYD CURL DR # 7914
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:248-762-8677
Mailing Address - Fax:
Practice Address - Street 1:2301 N 36TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703
Practice Address - Country:US
Practice Address - Phone:208-336-8801
Practice Address - Fax:208-466-5359
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29914122300000X
IDD-50221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice