Provider Demographics
NPI:1225392889
Name:SMITH, RACHEL LEAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LEAH
Last Name:SMITH
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 1:8680 BAYMEADOWS RD E APT 324
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3985
Mailing Address - Country:US
Mailing Address - Phone:941-447-5295
Mailing Address - Fax:
Practice Address - Street 1:1747 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4238
Practice Address - Country:US
Practice Address - Phone:904-495-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11538122300000X
FLDN19989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist