Provider Demographics
NPI:1174296305
Name:MALIT, RACHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:MALIT
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 1:511 FAYETTEVILLE ST UNIT 1906
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-3091
Mailing Address - Country:US
Mailing Address - Phone:919-696-5694
Mailing Address - Fax:
Practice Address - Street 1:12612 CAPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7489
Practice Address - Country:US
Practice Address - Phone:919-435-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice