Provider Demographics
NPI:1639393325
Name:AMBAT, RACHEL EPISCOPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:EPISCOPE
Last Name:AMBAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4941
Mailing Address - Country:US
Mailing Address - Phone:347-678-4732
Mailing Address - Fax:
Practice Address - Street 1:749 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4941
Practice Address - Country:US
Practice Address - Phone:718-388-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086066Medicaid