Provider Demographics
NPI:1760103717
Name:BLEDSOE, RACHEL ALLISON (RDH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALLISON
Last Name:BLEDSOE
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 1:272 DOGWOOD DRIVE
Mailing Address - Street 2:DENTAL DEPT.
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-3820
Mailing Address - Country:US
Mailing Address - Phone:276-524-3871
Mailing Address - Fax:
Practice Address - Street 1:272 DOGWOOD DRIVE
Practice Address - Street 2:DENTAL DEPT.
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3820
Practice Address - Country:US
Practice Address - Phone:276-524-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402208545124Q00000X
TN5639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist