Provider Demographics
NPI:1497987929
Name:RIEPE, RACHELLE ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ANNE
Last Name:RIEPE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:CLALLAM BAY
Mailing Address - State:WA
Mailing Address - Zip Code:98326-0137
Mailing Address - Country:US
Mailing Address - Phone:360-670-3135
Mailing Address - Fax:
Practice Address - Street 1:1830 EAGLE CREST WAY
Practice Address - Street 2:
Practice Address - City:CLALLAM BAY
Practice Address - State:WA
Practice Address - Zip Code:98326-9724
Practice Address - Country:US
Practice Address - Phone:360-670-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60105845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist