Provider Demographics
NPI:1619358082
Name:PULLIN, RACHEL BRINKLEY (DDS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BRINKLEY
Last Name:PULLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:BRINKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:112 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4035 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5152
Practice Address - Country:US
Practice Address - Phone:434-793-2045
Practice Address - Fax:434-793-8820
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist