Provider Demographics
NPI:1568442622
Name:NOWLIN, RACHELLE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:MARIE
Last Name:NOWLIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RACHELLE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2110 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3760
Mailing Address - Country:US
Mailing Address - Phone:813-777-8172
Mailing Address - Fax:
Practice Address - Street 1:THE OHIO STATE COLLEGE OF DENTISTRY
Practice Address - Street 2:305 W 12TH AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-257-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20561223G0001X
LA56981223G0001X
FLDN256391223G0001X
OH30.0262851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice