Provider Demographics
NPI:1467031310
Name:LUSS, RACHEL ELISE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELISE
Last Name:LUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 W ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5339
Mailing Address - Country:US
Mailing Address - Phone:845-352-5410
Mailing Address - Fax:
Practice Address - Street 1:375 W ROUTE 59
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5339
Practice Address - Country:US
Practice Address - Phone:845-352-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062829-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice