Provider Demographics
NPI:1184178865
Name:ANDERSON, RACHEL (DMD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ANDERSON
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 1:2101 W WHITE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5347
Mailing Address - Country:US
Mailing Address - Phone:972-924-2452
Mailing Address - Fax:
Practice Address - Street 1:2101 W WHITE ST STE 100
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5347
Practice Address - Country:US
Practice Address - Phone:972-924-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice