Provider Demographics
NPI:1245743921
Name:BRODERICK, RACHEL GERMAINE (RDH, EPDH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:GERMAINE
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:RDH, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18650 NW CORNELL RD BLDG C
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-9207
Mailing Address - Country:US
Mailing Address - Phone:503-848-5861
Mailing Address - Fax:503-848-5863
Practice Address - Street 1:18650 NW CORNELL RD STE 220
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9212
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:503-848-5863
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7362124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist