Provider Demographics
NPI:1518688894
Name:HUDSPETH, RACHEL ELIZABETH
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:HUDSPETH
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 1:74 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3003
Mailing Address - Country:US
Mailing Address - Phone:862-220-6161
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02927800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist