Provider Demographics
NPI:1467651497
Name:POPPEL, RACHEL ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:POPPEL
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 1:2717 EKKO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2070
Mailing Address - Country:US
Mailing Address - Phone:507-373-5968
Mailing Address - Fax:507-373-8410
Practice Address - Street 1:2717 EKKO AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2070
Practice Address - Country:US
Practice Address - Phone:507-373-5968
Practice Address - Fax:507-373-8410
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN443655000Medicaid