Provider Demographics
NPI:1417164393
Name:STONE, RACHEL LYANN (RDH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYANN
Last Name:STONE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 ESCONDIDO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1903
Mailing Address - Country:US
Mailing Address - Phone:706-587-7130
Mailing Address - Fax:
Practice Address - Street 1:6262 ESCONDIDO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1903
Practice Address - Country:US
Practice Address - Phone:706-587-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12747124Q00000X
GADH010003124Q00000X
KY3488124Q00000X
SC4118124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered124Q00000XDental ProvidersDental Hygienist