Provider Demographics
NPI:1578951422
Name:MOORE, RACHEL (RDH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDH
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 158
Mailing Address - Street 2:EL CENTRO FAMILY HEALTH
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:15136 ST. RD. 75
Practice Address - Street 2:EL CENTRO FAMILY HEALTH PENASCO DENTAL CLINIC
Practice Address - City:PENASCO
Practice Address - State:NM
Practice Address - Zip Code:87553-0516
Practice Address - Country:US
Practice Address - Phone:575-587-2809
Practice Address - Fax:575-587-2605
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3795124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist