Provider Demographics
NPI:1578964730
Name:LOGRASSO, RACHEL LAUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LAUREN
Last Name:LOGRASSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LAUREN
Other - Last Name:HURWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11344A CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-2807
Mailing Address - Country:US
Mailing Address - Phone:323-777-7420
Mailing Address - Fax:
Practice Address - Street 1:11344A CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2807
Practice Address - Country:US
Practice Address - Phone:323-777-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice