Provider Demographics
NPI:1326244823
Name:WILT, RACHEL M (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:WILT
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:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521-0072
Mailing Address - Country:US
Mailing Address - Phone:043-432-8211
Mailing Address - Fax:
Practice Address - Street 1:5861 MASON DIXON HWY
Practice Address - Street 2:
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521-8300
Practice Address - Country:US
Practice Address - Phone:304-432-8211
Practice Address - Fax:304-432-8213
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice