Provider Demographics
NPI:1164579389
Name:ABOU-EZZI, RACHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:ABOU-EZZI
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 1:555 TURNPIKE ST
Mailing Address - Street 2:# 55
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5923
Mailing Address - Country:US
Mailing Address - Phone:978-685-5562
Mailing Address - Fax:
Practice Address - Street 1:555 TURNPIKE ST
Practice Address - Street 2:# 55
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5923
Practice Address - Country:US
Practice Address - Phone:978-685-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0281646Medicaid