Provider Demographics
NPI:1649400813
Name:PHILLIPS, RACHELLE IRENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:IRENE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GINGER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3403
Mailing Address - Country:US
Mailing Address - Phone:618-954-8029
Mailing Address - Fax:
Practice Address - Street 1:2006 MALL ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1831
Practice Address - Country:US
Practice Address - Phone:618-345-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist