Provider Demographics
NPI:1275793390
Name:RODRIGUEZ, RACHAEL L (DDS)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 EXECUTIVE PL STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4260
Mailing Address - Country:US
Mailing Address - Phone:479-250-1516
Mailing Address - Fax:
Practice Address - Street 1:1521 EXECUTIVE PL STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4260
Practice Address - Country:US
Practice Address - Phone:479-250-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist