Provider Demographics
NPI:1437936044
Name:LUI, RACHELLE HELANE (RDH)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:HELANE
Last Name:LUI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:HELANE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4795B GUADALCANAL ST
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1955
Mailing Address - Country:US
Mailing Address - Phone:206-388-6025
Mailing Address - Fax:
Practice Address - Street 1:171 INNER LOOP RD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH35529124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist