Provider Demographics
NPI:1578790812
Name:FINE, RACHEL LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LYNN
Last Name:FINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:HOLLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1025 N BRAND BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2950
Mailing Address - Country:US
Mailing Address - Phone:818-242-1708
Mailing Address - Fax:818-242-0703
Practice Address - Street 1:1025 N BRAND BLVD
Practice Address - Street 2:STE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2950
Practice Address - Country:US
Practice Address - Phone:818-242-1708
Practice Address - Fax:818-242-0703
Is Sole Proprietor?:No
Enumeration Date:2009-06-13
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18395122300000X
CA58367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist