Provider Demographics
NPI:1336663210
Name:DEWITTE, RACHEL (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DEWITTE
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 1:9955 BUFFALO SPEEDWAY APT 16105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1353
Mailing Address - Country:US
Mailing Address - Phone:505-920-9789
Mailing Address - Fax:
Practice Address - Street 1:108 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3819
Practice Address - Country:US
Practice Address - Phone:281-992-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice