Provider Demographics
NPI:1477829778
Name:DAVIDSON, RACHEL RAE (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RAE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:RAE
Other - Last Name:SUESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1024 E BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3931
Mailing Address - Country:US
Mailing Address - Phone:360-393-9287
Mailing Address - Fax:
Practice Address - Street 1:1800 LINCOLN WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2570
Practice Address - Country:US
Practice Address - Phone:208-667-9110
Practice Address - Fax:208-676-1272
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist