Provider Demographics
NPI:1235581331
Name:RACHAN, TANYA NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:NICOLE
Last Name:RACHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:NICOLE
Other - Last Name:FLESHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9490 FM 1960 BYPASS RD W
Mailing Address - Street 2:700
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4099
Mailing Address - Country:US
Mailing Address - Phone:281-446-9933
Mailing Address - Fax:
Practice Address - Street 1:9490 FM 1960 BYPASS RD W
Practice Address - Street 2:700
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4099
Practice Address - Country:US
Practice Address - Phone:281-446-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist